A Tale of Two Centricities

In my old practice, I had an Electronic Medical Record system (EMR). The paperless office: all patient data entered in real-time into computers, all documents scanned, even digital photos transferred directly into the record. No more searching for lost charts, no more waiting for the front desk to hand the chart to the nurse who then hands it to me (who hands it back to the nurse, who then hands it back to me, who then returns it to the front desk); no more trying to decipher doctor's chicken-scratch handwriting; instant access to every patient's record from any computer with an Internet connection; and most importantly, near-complete recovery of every single patient record after the most devastating disaster in recent history.

That EMR was provided by a company called eClinicalWorks. They're a good little company with a good, nimble, customizable little product. It's far from perfect, but it did the job really well, and very affordably. I think of eClinicalWorks as a butterfly: small, delicate, and beautiful.

The practice I am now in uses a different EMR, called Centricity, from GE. Yes, that GE (you'd be surprised to learn how much GE is involved in health care). If eClincalWorks is a butterfly, Centricity is a hippopotamus. Big, lumbering, powerful, and utterly without grace. It's not going to listen to you unless it wants to.
I actually don't have much complaint against Centricity. Like eCW, it also does the job. It does many things eClinicalWorks never could (such as scale up to a massively multi-user, multi-site organization, the opposite of the solo private practice; also robust user-tracking, recording who entered and changed what in the record); I bet--though I haven't yet had the chance to find out--that it is much better at data collection and analysis. It's been fairly easy to learn and use, and hasn't significantly slowed down my work, or interfered with patient interaction.

But it does have some major drawbacks. Only one person can work on a record at a time, lest you risk crashing the program. The printed output leaves something to be desired. Small program changes have to be referred to the clinical committee, which then refers changes to the organization's IT department, who then sometimes has to work with GE's programmers.
Most interesting of all, the program's biggest strength is in collecting and recording patient background data: what language they speak, how they prefer to learn new information, if they have cultural concerns, etc. Combine that with its privacy features and user-tracking, and it seems that it was created with HIPAA and regulations first.

Privacy and compliance is important, yes. But I'm more than a little concerned that this product seems to have placed that area as most important--and physician input, management of assessment, plans, medications, immunizations, and such becomes second tier. I imagine a different Centricity, created first and foremost as an Electronic Medical Record: patient data, ease of entering and retrieving it, being the priority. Lay the compliance onto this template, add a pretty interface, and *boom*--you've got a revolutionary new product. However, that's not the Centricity that GE decided to create.
(It's all the more frustrating that this big expensive product was created by a big powerful company like GE. You'd think that GE would have the resources and insight to do it better. Of course, that might be part of the problem right there: hey, we at GE don't have to listen to those doctors or medical practices; we're smart enough to do it ourselves, with what we think is important. If you don't like it, that's tough, because we're big ol' GE, and we know best.)

And so we're still waiting for that hypothetical ideal EMR that satisfies all parties and concerns.

Yes, here in 2007 we still have a long way to go. (Though, did I mention that we're using the 2004 version of Centricity? There's an update, but it's still in beta. Our organization has, quite wisely, decided not to trust its patient data to an unfinished product.)

And some people wonder why doctors have been slow to switch to EMRs.