“You’d be hard-pressed to find a physician who says they like using their EHR.”
That massive understatement comes from Dr. Henry Chueh, chief of biomedical informatics at Massachusetts General Hospital in Boston. Chueh also is a consultant to Amazing Charts, a vendor based in North Kingstown, Rhode Island, that is trying to change physician attitudes toward EHRs by embracing an old standby, the problem-oriented medical record.
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Amazing Charts, owned by medical education content provider Pri-Med since 2012, is getting ready to roll out Pri-Med InLight EHR, a software-as-a-service product built with a problem orientation. Amazing Charts licensed OnCall, the problem-oriented medical record developed at Mass General after the hospital’s parent organization, Partners HealthCare, began switching all of its facilities over to an Epic Systems EHR in 2014.
InLight soft-launched a year ago, according to Amazing Charts President John Squire. Amazing Charts will formally launch InLight to its existing user base in the next few weeks as an alternative to its existing EHR products, he said.
“We think we have something that’s unique in the market,” Squire said. The POMR is built into InLight’s data model rather than created by applying filters, as other vendors tend to do. “At Mass General, they took a different approach,” Squire said.
Mass General developed OnCall based on the work of medical informatics pioneer Dr. Larry Weed, who created not only the problem-oriented medical record but also the SOAP note, which stands for subjective, objective, assessment and plan. Chueh said OnCall started in the late 1990s, but its roots go way back to Dr. Octo Barnett, who co-developed Computer Stored Ambulatory Record (COSTAR) at Mass General, based on Weed’s vision, in 1968.
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(Interestingly, COSTAR was written in MUMPS, the Massachusetts General Hospital Utility Multi-Programming System, which forms the basis for Epic and other large commercial EHR systems — the same EHRs that physicians love to complain about. Chueh co-directs the MGH Laboratory of Computer Science, which Barnett once ran.)
Other than MUMPS, a common thread that connects many established EHRs is the fact that they originated as billing systems. They also were built more to take in transcribed clinical notes than to fit physician or nursing workflows. Chueh said.
“The problem-oriented medical record is hard to make flow” in an EHR, Chueh said. The POMR divides the medical record into four components: a database with medical history, physical examination and test results; a problem list; an initial list of orders; care plans; and progress notes, often including a discharge summary. It’s usually organized into the SOAP format.
OnCall wasn’t mandatory at Mass General because Partners had another EHR that users could opt for. “People came to us to use OnCall because they really liked it,” Chueh said. “For clinicians, it feels more like it’s supporting their clinical work.”
That’s the feeling Amazing Charts hopes to replicate in independent practices, Squire said.
At HIMSS16 earlier this month, Squire was surprised that practices were investing so much in population health and patient management, but not focusing much on optimizing their EHRs, he said. “We think that’s dead wrong,” Squire said, because neither is directly related to clinician workflow. “We think you should focus on what docs use daily.”
Photo: Amazing Charts
