Top Derm EMR Requests

Sorry for the slight delay in getting this post out. Last week was packed full with Daixo attending the Ann Arbor SPARK Entrepreneur Boot Camp.

As promised, here is a list of some of the most requested things we have heard from dermatology professionals in roughly the order of importance.

Top Ten EMR Requests for Dermatology

1. As fast as paper records!
2. No insignificant non-derm clutter
3. Multiple chief complaints
4. Visual locations of problems
5. Templated forms for problem type (e.g. acne, growth, rash, etc.)
6. Some connection to existing billing system
7. Ability to add non-electronic records (e.g. referral letter)
8. Diagnostic photographs
9. Ability to create paper records (i.e. print out a patient encounter)
10. Quickly review and sign multiple chart

This list is by no means exhaustive, but I feel represents a large majority of the most important issues of EMR concerning dermatologists. But please, if you feel I’ve left out important issues, or maybe you disagree with something (perhaps you’d reorder them), speak up! The more I know, the better an EMR solution I can make for dermatology!

Interesting Observations in Derm Offices

In an effort to make this much more interactive and far less preachy than my blogs have been so far, I am going to really try and keep my posts short and succinct. If you have questions, comments, or just want to know more about a topic, please feel free to post a comment and we can carry out the conversation from there!

That said, for this week, I promised I’d identify a few of the interesting things I have seen in my past year and a half of touring dermatology offices. To make this more pertinent, I thought I would frame the observations from the “interesting challenges for EMRs to handle” perspective. So below, you will find a list of a few things I have seen. If any of these are different from your practices, or perhaps, you are really concerned with, please say so!

Observation 1: Sticky notes on charts – Offices love writing short notes to doctors and sticking them to specific pages in a chart, or on the folder itself! Bottom line – sticky notes are a great form of communication.

Observation 2: Stacks of charts – Offices love stacking charts in piles. Piles might be of charts that need reviews, or signatures, or even just to be refiled. Bottom line – stacking charts is a way of organizing.

Observation 3: Note pads – I encountered all sorts of individuals in different roles who carried little note pads with them to write strategic notes on all day. This included doctors, PAs, MAs, and even front office staff. Bottom line – there is a lot to do in an office and sometimes you are forced to do a new task before the first is completed.

Observation 4: Reference Materials – Every office I visited had a plethora of reference materials spread strategically throughout the office. Sometimes it was a PDR, sometimes it was photocopied notes of lab phone numbers. Bottom line – there is a wide range of information needed throughout the day, some of which is often referred to, others rarely.

Observation 5: Organized Chaos – Each office has its own protocols for patient in, treat, and patient out procedures. To a casual observer it looks like mayhem. In fact, there is a little magic to the rhythm, but there is also an underlying process. Bottom line – a new process must fit within the existing one or it will fail miserably.

Observation 6: Privacy and Nudity Notices – Certain patient procedures require extra concern over privacy and/or nudity. One method for flagging these cases is a colored sign attached to the doorknob of these exam rooms. In this case, only the appropriate personnel would enter the room at the appropriate times. Bottom line – not all patient interactions are alike and some require special practices.

Observation 7: Dermatologists love pictures – Having photographic records of every lesion a patient has ever had would be ideal for a medical record. Unfortunately, this can be costly and quite difficult to manage. Bottom line – we all see diagnostic photos as the Mecca of any dermatology EMR.

What do you think? Any comments on the above observations? Any other ones you think might be important as we begin to look at the future of dermatology in the digital age?

Next week: Top requests I have heard for EMR in dermatology!

Transparency and Trust in Business

In the past, I have described Daixo as “first and foremost a member of the community” working with dermatologists to develop and deliver an ideal EMR solution. When I explained our desire to be more than merely a provider for dermatologists, but a partner, people often doubted the sincerity of my statements. Since I have started writing this blog I have been directed to an MIT professor, Glen L. Urban who popularized the concept of “trust-based” (advocacy) marketing. His research explains the business rationale many find unbelievable.

Advocacy in business can be a difficult concept to understand as it represents a paradigm shift from the traditional brute force marketing tactics we have come to accept over the past half century. The fact is, no longer can firms force-feed consumers with their “picture-perfect” sales pitch. The cat is out of the bag with the internet and companies can no longer shelter their consumers from the truth. If your product is inferior, your market will know that.

Websites like ConsumerReports.org and CNET provide users with countless professional reviews and recommendations on a wide range of products. Even without a staff to rate products, sites like Ebay and Amazon.com have proven that other users can be a highly effective and trustworthy source of feedback!

Some companies are afraid of this transparency because it is so foreign to their existing business process. For Daixo, we understood the new relationship between company and prospective customer (although we didn’t call it “advocacy”). The only way to ensure a sustainable business in this new age is to work with the customer, constantly striving to best meet their needs.

This is why Daixo chose to focus on dermatologists before we expand into any other medical specialties with our EMR solution. By selecting a niche, we can work to develop strong connections to our customers and a deep understand of their changing needs. Only then can we hope to build them the best solution available.

But its not as simple as selecting a niche market. We want to develop a trusted relationship with every dermatologist possible. We have learned something from each and every dermatologist we have worked with to date. And when we design a screen for use in Daixo, we recall what we heard in each and every discussion with potential customers. Furthermore, as an informed technology partner and advocate, we can help shape the EMR landscape providing a different perspective on the regulatory discussions. Ultimately, we want to use our powers for the forces good! :-p

Each and every step along the way, Daixo is striving to be open and honest about our product, our business, and our company. We have nothing to hide. Besides, we couldn’t hide anything if we wanted to!

Originally, I began thinking of this post in terms of transparency in business, but seems to have taken a detour to trust and advocacy. To me, they are tightly woven. Without transparency, I cannot expect you to trust me. Without trust, my hands are tied because I rely on communication with you to help discover your ideal solution. If I’ve done my job right, the ideal solution (for some of you) will be Daixo. It is a symbiotic relationship.

For more reading on Glen Urban’s research on customer advocacy, I strongly recommend Customer Advocacy: A New Era in Marketing? (2005).

Next week I’ll begin challenging you, the dermatological professional, with interesting questions and observations I have made over the past year and a half. I have seen some interesting processes and they have greatly shaped the designs of Daixo. Should be fun!

How to gain understanding

Daixo was formed because we knew some dermatologists who were absolutely frustrated with the lackluster electronic medical record options available to them. We vowed to build an application that would be usable by human beings and not require months of training to become proficient with. Furthermore, we made it our goal to make an application that met their needs with no customization required.

To achieve this, we have set out to understand you, the potential user of our product. You see, understanding is the only way we can build a solution that truly meets your needs. Below, I will describe a series of activities that we use regularly to continually grow our understanding of dermatology. This methodology is one I learned while working as a High-Tech Anthropologist at the award-winning software firm Menlo Innovations.

Observations of existing processes
It’s no secret, people learn better through experience. It’s also commonly accepted that if you ask someone about a routine of theirs, they will oversimplify their answer and often completely neglect to mention key steps in the process. To combat this, the most important tool in understanding I have is to simply observe existing practices that my software will supplant. Translated into English, this means that I follow around the prospective users and witness first-hand the tasks and challenges they encounter in a given day as they actually happen.

For Daixo, I was fortunate enough to actually put on a lab coat and followed dermatologists around on their daily activities. I got blank copies of all forms filled out at a number of different dermatology clinics. I watched as medical assistants went about their daily routines and I even attempted to track who was touching the patient record throughout the day. These observations occurred in several clinics (some using paper-based and others using electronic medical records systems) over the course of several months.

As I developed a deeper understanding and internalization of the process I confirmed exactly what I was seeing through discussions with various medical personnel. The pinnacle of this was building a model of the life of patient records and how they fit into the practice of dermatology. Far beyond memorization of requirement requests, I was able to truly understand the challenges of the structure and workflow for any record system based on what I witnessed first-hand. Thus, I was able to develop a more sophisticated solution for how our application can better meet your needs.

Interviews
Second only to observation, interviews with actual dermatologists and dermatology professionals (medical assistants, office staff, etc) are an invaluable tool for understanding. The simple act of listening to what works and what doesn’t work with other existing systems is more meaningful to a designer than reading all the market research reports in the world. This is exactly why I post my email address and phone number on all emails I send out. At Daixo, we want to hear what you have to say! It is common sense, but if I can talk to 5 dermatologists about what they need, chances are my EMR is going to suit those (and all) dermatologists better than if I was guessing what they wanted.

Weekly design and development assessments
Every week that we have produced new designs (paper mockups of what the software will look like and what it will do) or written actual code we have shown this progress to at least one dermatologist. We do this to constantly confirm that we understood correctly what we saw and heard through our observations and interviews and that we are interpruting that correctly via solutions in our software. Additionally, we are gaining confidence in our product as a viable solution to record keeping in dermatology.

An added benefit is it becomes increasingly difficult to stray too far from the core requirements of our application when potential users are continually critiquing our developing product based on their primary needs. This layer of verification is just one of our many important methods of transparency (which we will talk more about in a later blog).

Conferences (lectures, workshops, etc)
Daixo has attended the past two Annual American Academy of Dermatology Meetings (Washington DC, 2007 and San Antonio, 2008) as well as the  2007 Summer Academy Meeting (New York, 2007). We did not have a booth, but instead attended talks, workshops, and everything related to EMR and dermatology. We ask questions when we wanted to know more. We answered questions when we had useful information. And we even brought up challenging issues when we felt that dermatologists best interests were not being served.

You see, Daixo sees itself as a member of the dermatology community not simply a vendor. Everyone knows EMR is coming, but there are far too many hurdles to make it effective yet. Rather than trying to be opportunistic amdist the confusion, we want to be an advocate for good electronic medical recordkeeping in dermatology. To borrow an economic phrase,a rising tide floats all boats. By participating in the dialog of EMR in dermatology, we can only further improve our understanding of what dermatologists need and ultimately, build a better solution for you.

Closing thoughts…
A great strength in our process is our committment to communication and transparency. You can see how our desire for understanding and our methodology for gaining that understanding is all about the interaction between you, the user, and me, the software designer. I will again encourage you to contact us with any feedback you have about what you’ve read, anything about your experiences in the field of dermatology, or anything EMR related. As always, feel free to email me and let me know what you think!