Information Technology Reference
In-Depth Information
scanning integrated with bar code technology so the system would understand the
contents of each scanned document, technology Doug had previously developed for
banking. They began with dermatology, providers who were used to dictating and
transcription. Because of its image management, the service allowed them to more
compactly have their dictation and diagrams in one place. In these dermatology
practices MIE claims to have eliminated paper charts while reducing the number of
transcriptionists from 6 to 2 by increasing their productivity.
In 1998 MIE introduced WebChart (which may well have been the first web-
based EMR) and their “Minimally Invasive EMR™” around 2000. Doug feels that
physicians are and should be “cognitive not clerical”. The system “learns” each doc-
tor's practice patterns and, over time, can predict what they are going to input and
fills it in for them, a concept that is now widely used in the system. These learned
concepts are not problem specific. Instead the system answers questions based on
the patient's history and the most common questions for each chief complaint. To
give a simple example, in a case typically requiring antibiotic therapy, the drug the
physician has most often used in the past for similar cases would appear first on
their list of choices. These preferences (e.g. each physician's approach) are built
into a “medical library” allowing nurses to switch libraries as they rotate among
physicians. MIE provides some interesting case studies on its web site. [
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Today MIE has around 3000 physician users across the US and around the world.
The company also offers a fully integrated personal health record called
NoMoreClipboard. Partially as a result of offering both capabilities, it is used exten-
sively in occupational health clinics for major employers who typically use both the
EMR and PHR. To give one example of the integration, the EMR evaluates each
patient's risk of developing particular chronic diseases, such as diabetes or hyper-
tension, and tells the EHR what questions each patient should answer in the PHR to
further evaluate that risk and monitor their progression toward that disease or their
success in helping to avoid it.
Praxis
was founded by Richard Low, a UCLA/Yale educated physician, who
first trained in surgery and did emergency medicine before shifting to internal medi-
cine. He recalls attending a seminar given by a physician/lawyer and first realizing
how important medical documentation is. He later found out that the
“
average phy-
sician spends 2.5 hours per day doing paperwork, that's 8.5 years of his career.” He
examined clinical records and determined that “no two doctors chart the same”. His
dream was to develop something that would save doctors time while allowing them
to maintain their individual approach to charting. He started Praxis in his native
Argentina in 1989 with $15,000 of his own money which, he says, went a great deal
further there than it would have in the US. Praxis was introduced in 1993 and since
its second product release in 1998, has grown as a profitable company with no out-
side financing. The company is now based in Marina Del Rey, CA.
Ironically the way Praxis makes documentation more efficient for physicians is
itself not easy to understand. At its core is the notion of a “clinical concept”. Praxis
does not define concepts in a standardized way as SNOMED does. Rather they con-
sider a concept an indivisible clinical unit
in the view of each individual physician
. In
essence a concept is a basic element of the way the physician thinks about medicine.
