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Blunders and Wonders: Unusable EMRs & Smartphone Ultrasounds


Why we’re thinking about EMRs all wrong, and how mhealth gives us new windows into the human body.

Hello! I'm Dr. Nick, the Incrementalist, and I'm here today to talk about Blunders & Wonders.

Blunder: Usability and the EMR

This week's Blunder: Usability and the electronic medical record (EMR). The Journal of Medical Informatics and Health and Biomedicine, or JMIR, published a study recently on the usability of electronic medical records.

There was so much to unpack in the details of the study, but one data point stood out to me: 61 clicks required to prescribe Tylenol for a patient every four to six hours. This worked out to over a minute of time.

As one commentator online noted in an exchange with me, they struggle to reconcile this with the ubiquitous nature of barcode scanning capabilities that we're finding extremely efficient, and are making our everyday lives easier. Most frequently for most of you, this occurs in the supermarket, where the purchase of scanning items has devolved down to the individual shopper in the self-service aisle.

But even with barcode scanning you can still find major inefficiencies in the design of workflow and it fails to take account of the circumstances on the ground. Imagine if the supermarket required you to scan the shelf sign, scan the shopping list, then scan the item itself on the shelf, open the box, take out one of the items, scan that, scan your cart...

Well, you get the picture. Now mistaking penne pasta for linguini is not a total disaster, unless of course you've got a three year-old who refuses to eat anything but penne pasta. But in medicine, getting the wrong drug to the wrong patient is a huge safety issue.

It comes back to designed thinking - that we should start with no preconceived notions or mandates, otherwise it risks just automating an existing process with technology that offers so many alternatives to the way that we can rethink the design.

We saw the move from steam-powered machinery that had pulleys that failed to immediately apply the thinking around electric motors, and just replicated the system of pulleys that were necessary for the steam-driven engine. It was some time later that rethinking the design placed those motors conveniently at the point of the production line.

So it is with EMRs. An automated system optimized for paper introduced inefficiencies that take away the clinician's focus from their patient and onto the technology.

Wonder: Smartphone Ultrasound Transducer

This week's wonder: the ultrasound transducer that could turn a smartphone into an ultrasound machine for $100.

There's no question that ultrasound technology has had a major positive effect on medicine. It's added amazing new insights into the workings of our bodies and to the process of diagnosing and understanding disease. In fact, the original insights came from the animal kingdom and the echolocation capabilities of bats that were given a boost following the sinking of the Titanic.

We've seen advances of this technology with the addition of different modes, adding Doppler sensing, and offering progressively more information and more detail to the output.

All these systems are based on piezoelectric crystals that vibrate to produce the ultrasound waves, but researchers at the University of Columbia have broken that mold with a new transducer, replacing the piezoelectric crystals with a tiny vibrating drum made up of a polymer resin called polyCMUTs, or polymer capacitive micro-machined ultrasound transducers, which have lower power requirements, fewer manufacturing steps, and are hence cheaper to manufacture.

The images seen were as good, and in some cases sharper than those produced with traditional piezoelectric transducers. Based on their research, it looks like we could be seeing transducers miniaturized to the size of a small band-aid that could be stuck on the patient's chest for continuous monitoring, opening up a whole new domain for all this data and collection and insights into individual bodies and organs and functions.

Until next time, I'm Dr. Nick, The Incrementalist. Don't let perfection stand in the way of progress.

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