All of the points you mentioned in your post are valid and prescient, especially in these times when we need an infusion of new ideas in our healthcare system to improve care and lower costs. I stand with your philosophy and as a fellow physician who has been in your shoes as a solo independent primary care physician, I’d like to offer an opportunity to see my project that happens to also be a tool. Firstly, as opposed to other EHRs, mine is open source (as you indicated a preference of how such a prototype would be conceived). I’ll go over a brief checklist to show you that such a prototype already exists and let’s combine our cognitive efforts to make this even better. I’ll be referencing some these comments to my blog (google NOSH ChartingSystem) and you’ll see what I’m talking about.
“No focus on billing codes, instead a focus on work-flow.” – NOSH is designed to be workflow aware from a physician’s point of view. Billing is secondary and billing companies don’t like my system for just that reason (I’ve had to work with some of them and they are certainly confused because it’s not like any other EHR they have seen).
“Documentation should only be for the sake of patient care. I need to know what went on and what the patient’s story is at any given time.” – I agree. NOSH isn’t designed to make sure you bill correctly and have all the documentation needed to meet the level of service, etc. It was designed to allow a physician to view pertinent clinical data in as little steps as possible to get it.
“Focus on chronic care, communication tools, and patient reminders for all patients, regardless of whether they are in the office or not.” – NOSH has a built-in reminders system (for any orders you make for instance, automatically without additional input, so that you don’t lose track of orders that were made and needing results). NOSH is completely web-based so that you can access it from anywhere, securely, as long as you have a web browser.
“A collaborative record, sharing most/all information with patients so they can use it in other settings for their care. Also, I want patients to have edit privileges for things they better suited to maintain, like medication lists, demographics, insurance information, and past history items.” – NOSH has a built in patient portal that does most of what you just mentioned. Patients can message to your provider securely within its own network with this portal feature, schedule appointments, review results, and pretty soon, patient forms that get incorporated into your chart/encounter without having the extra step of re-entering data from paper to digital.
“Since the goal is to share the record and to maximize care quality to make communication more efficient, organization of the record is crucial” – Check out my live demo (the real thing, not a screenshot or a need to contact me to schedule a meeting). You’ll see that organization of the record is geared to a clinical first and foremost in a simple, uncluttered interface.
“Task management is near to the top.” – The first screen you see when you log into NOSH is a task list.
“My goal is to give patient access to accurate medical information and access to me in a way that is easy and efficient. Mobile technology is the most obvious means to this end.” – NOSH is totally usable for mobile devices (iPads, tablets, and phones) out of the box because it is web-based.
“I believe we should focus far more on reducing risk factors than on treating “problems.”” – I totally agree. One of the new features being developed currently is the ability to do tagging of any element of the chart and encounter. Tagging allows physicians (like the way tags work on blog systems) to categorize any aspect of the chart so that it can be analyzed later for any reason. It the tag is not restricted to diagnoses codes or problems (it can if you want). That is the total power of personalization that NOSH can accomplish.
“I think this is best done through making it open source and setting up a foundation to fund the program (and let me gladly hand it off to people who are better at this than I am).” – I agree. The cool thing about open source is the ability to collaborate openly. And there is no right way to do it and open source gives anyone the ability to agree to disagree about how a product should work. I give full license to anyone who wants to fork my project for other purposes because I know that every health care provider is different. As an open source project leader, software coder, developer, and a practicing physician, I totally get what you are looking for. I’m already working with some other health care providers that get this too (locally in Portland and all across the world and through this project, we are building a community. Come join us. Google “nosh chartingsystem indiegogo” to know more about my project and my current Indiegogo crowd funding campaign to spread the word about my quest to change the health care IT landscape for the benefit of independent and outpatient health care providers of any specialty.