EMR has been around a long time, but very few people are actually using it. The reason is simple -- most systems are much harder to use than simple pen-and-paper, and the burden of using them offers no visible gain. In short, they are expensive, time-consuming to use, and offer no improvement to patient care or the health of the practice.

When we undertook to put EMR into Andromeda PMS, we knew that a fresh approach was necessary. We worked carefully from day one with a handful of doctors to hear what they wanted and what they were not seeing in the competition. The result was our unique definition-oriented system, which is very flexible, configurable, easy, and never restrictive.

Definitions Instead of Templates

We heard a lot of complaints about templates. Three big ones were these:

• A fixed template of questions slows down the doctor with irrelevant clutter on the screen.
• Inaccurate Records! One doctor told us of a template for a new mother visit that contained the question, "Does the mother breastfeed?" If the doctor had no reason to ask that question on that visit then the notes would say "Breastfeeds: NO". This is flat out wrong!
• Detrimental to patient care. Clunky or clumsy software causes the doctor to focus on the computer instead of the patient. Doctors want something that is no more effort than pen and paper.

In data processing terms, we say that a template imposes a structure on the information that does not reflect reality. In medical terms we say that the computer is attempting to practice medicine!

What we realized in this analysis was that the doctor had three basic needs:

• During the visit, the doctor must be in total control of the flow of information.
• During the visit, the doctor must be able to add any note whatsoever at any time -- the computer must never attempt to practice medicine.
• During and after entry, the notes must be as easy to retrieve as if they were written on paper. We worked out that every note must always be reachable with no more than two very obvious mouse clicks.

"Free" Coding

Andromeda EMR eliminates manual coding of claims. As you enter the notes for the SOAP process, some of the notes will correspond automatically to diagnosis and procedure codes.

As a simple example, if you diagnose the patient with Otitis Media and make a note, there is no need to mark an encounter form or have your biller put in the code. Since you have already made the note the computer now knows. The same goes for simple examples like shots, but it works just as well for more complex procedures.

Lefty or Righty?

Andromeda EMR is meant to be used with a very lightweight tablet PC. The PC weighs in at just over 2 pounds, and can easily be carried through an entire shift.

The funny thing about a tablet PC is that while you are using it you actually cover a good portion of the screen with your hand. We took this into account with our design, putting the least used portion of the screen under the hand, and the working surface right under your index finger. Then we added a lefty-righty switch so that it works for everyone!