PracticalDermatology

Though it is unlikely to endure, now is a relatively quiet time for Electronic Health Records (EHRs) on the Meaningful Use front. With the HHS extension of Stage 1 benefits, providers now await further information on Stage 2 and perhaps even a first draft of the Stage 3 proposed rule. Despite the lull in activity on the government front, EHRs continue to grow more prominent in medicine and dermatology. At the upcoming Summer meeting of the American Academy of Dermatology in Boston, I will again serve as chair of the EHR symposium dating back several AAD Meetings, in which physicians share their experiences and insights with a particular EHR system. Two newcomers to the symposium this year include Praxis and EZ DERM.

As a companion to the symposium, for this month's article I spoke with two expert: Allen Natow, MD, a physician in private practice who uses the Praxis system (and also a presenter at the AAD EHR symposium), and Srdjan Prodanovich, MD, founder and president of EZ DERM.

What is your current read on the state of EHRs in medicine and dermatology, and how will the marriage of digital technology and healthcare take shape in coming years?

EHRs are certainly here to stay. I am not sure that cloud computing is here to stay, at least not until we have enough redundancy built into the clouds to make communication failure essentially unknown. Data sharing among health providers will likely increase as more facilities have somewhat standardized health records. Whether this will actually lead to improved care or lower costs, however, remains to be demonstrated.

Can you talk about your impressions of Praxis and how it has affected your methods of practice and daily operations?

Praxis is a very powerful and complex program. Having used it full-time for approximately three years, I believe that I still am using only 10 percent of its feature set. Almost always when I look for another feature in the program, I find that it is already present and easy to implement.

We find that we rarely have patients return to the office with outstanding lab work not in the chart since Praxis automatically reminds my assistants to query the lab prior to the patient's return visit. We also find it very easy to keep track of each patient's important problems since the program displays that easily on demand. We also have a very easy time documenting chronic skin findings in the chart since that is also very easily tracked with the program.

Can you talk a little bit about the interface?

Praxis has an excellent user interface. It has a template search engine that is extremely powerful and easy to use. Thus, finding the best template among hundreds of templates is not difficult at all. Customizing an existing template to fit a new situation is very easy, and it can then be saved, usually in real time, for future use. Making a new template is so easy, and search/retrieval is so fast, that we really find that we work more and more rapidly as we continue to use the program and produce increasingly specialized templates.

One other aspect of the interface that is not easy to appreciate at first has to do with the fact that essentially all charting is performed from a single screen. So, at all times, no matter how many problems a particular patient has, the entire chart entry can be visualized as it is being built. Therefore, there is little chance to contradict one problem's entry with another, and it is easy to add to one physical finding as a second problem is documented.

Have you encountered any frustrations in making the switch from paper to electronic? Are there any elements that have run more smoothly than you expected?

Getting accustomed to charting using structured data can be difficult since many of us have rather disorganized thoughts when we chart free-form on paper, and this does not transfer well to an EHR. On the other hand, e-prescribing requires rather little effort to learn and is a true labor saver.

What is your take-home message about how to incorporate EHRs into practice?

The correct technology can permit you to practice medicine better and not take up any more time in your workday than traditional charting on paper. Do not get wowed by EHRs that ship with a large amount of pre-loaded templates, since often those are written with a mind-set and in a language that does not match your own. Pay attention to the overall health of the EHR company and visit other offices to see the EHR in action. You will be spending a great deal of time interacting with the software; be sure that it is a good fit for you and your style of practice.

How did you become interested in EHRs and begin developing one?

In 2006, I opened my dermatology office and decided to implement an Electronic Medical Record (EMR) system. After months of researching EMRs, I purchased a system only to realize that it was impossible to efficiently use in a busy dermatology practice. Most of us, dermatologists, are not software engineers. We want to focus on our dermatology patients, and not on dermatology EMRs. Even today, there is no such system available. With that in mind, I committed myself to developing software that could help us see our patients in an efficient and intuitive way, worthy of the EZ DERM name.

Can you talk about EZ DERM and how it can be situated in the growing EHR market?

There are many EMRs on the market today. However, as a recent survey in the February issue of Dermatology World has shown, only 33.7 percent of dermatologists are satisfied with their EHR software. Can you imagine if only one-third of pilots were satisfied with their auto-pilot systems? Clearly, there is room for improvement, and I firmly believe that we have found a better way to dramatically improve user's satisfaction.

Most of today's EHRs are based on two-dimensional images of the human body. Imagine having a digital album containing multiple photographs of the human body. Every time you will need to open and close the photos in order to go from one body part to another, many of the times you won't be able to find the desired angle of view, and none of the times you will be able to compare entered information on one photo with another. This is very inefficient rationale and is, unfortunately, what users of these systems struggle with on a daily basis today.

With integration of our three-dimensional interface and voice-recognition technology, we opened another dimension in terms of efficiency and user interactivity that resides on the omnipotent iPad®. This approach more closely mirrors the way we see patients today, and is significantly more intuitive to use, not only to dermatologists but also to their staff.

In addition, this patent-pending technology has clinical decision-making capabilities that just cannot be paralleled with obsolete 2-D technology.

Do you have a take-home message to fellow dermatologists regarding both your system and the importance of EHR technology in the practice of medicine?

There is a tremendous push, not only by the government but also by some medical billing authorities—that have vested interests in the companies on the market to adopt the current systems—at the brink of the revolution that will occur in the EHR market very soon. This creates a lot of anxiety among dermatologists to act now.

The fact is that you will forfeit only $5,000 of the Meaningful Use incentive money if you do not implement an EHR system by October 3, 2012. The 85 percent donation of the pathology labs has been extended to the end of 2013. It is, therefore, in my opinion, more prudent to hold on a decision to implement an EHR until the next year, and not make the same mistake I did in 2006. Remember, Google® came after Yahoo®, and the iPhone® came after Nokia®.

Mark Kaufmann, MD is co-chair of the Dermatology work-group for CCHIT. He is on the Medical Advisory Board of Modernizing Medicine.