BLOG: Emra, Alexa's unborn cousin

ByJohn A. Hovanesian, MD, FACS

What if I had a virtual assistant who could do for electronic medical records what Alexa, the little electronic cylinder in my kitchen, does for my family? At a family member’s request, Alexa can recommend to my wife a recipe for chocolate chip cookies, read me the latest press release on Takeda or make flatulence sounds so realistic for my 8-year-old that he will convulse with laughter (OK, I’ll convulse, too).

Let’s give this mythical electronic assistant the name “Emra,” a feminized nod to the EMR abbreviation.

In my fantasy, Emra could take the place of my full-time human scribe who works for me in my practice and do the same time-saving work for every member of my staff. She would recognize the voice of the workup technician and listen to the verbal patient history, entering elements like chief complaint, history of present illness and review of systems into their appropriate data boxes. She would record the dictated visual acuity, refraction, IOP, etc, as the information is collected by the technician. Based on the complaint and findings, she would remind the technician to perform additional appropriate tests like an OCT or topography according to established standards. She would warn the tech to consider not dilating a patient with a history of shallow anterior chambers.

For me, Emra would have a smartphone or iPad app that would help me be a more informed doctor before I walk in the room. She wouldn’t let me miss a high IOP or forget to speak loudly for the hard of hearing. She would remind me that Mrs. Jones has a canary, just got back from an Alaskan cruise or had a husband who died a few months ago.

In the exam room, Emra would know that when I say the words “3+ NS OD” in my exam findings, she should also automatically add a diagnosis of “cataract, moderately dense, right eye.”

She would record the impression and plan as I dictate in shorthand, creating a longhand, legal record as well as a single-page summary with common abbreviations for sharing between doctors.

When I prescribe a drug, Emra would search the patient’s insurance formulary to confirm a compatible selection or ask me if I would prefer a no-drama alternative. And I could ask any time, “Emra, what NSAID drop is on this patient’s formulary?”

Emra would be smart enough to know that when I order tests like visual fields, she should follow up later to make sure that the test was performed (or at least scheduled), interpreted and coded to insurance. If not, she would alert the appropriate staff member. Speaking of coding, she would gather all those pesky elements from the history and physical exam to select an audit-proof level of service for each visit. And, oh yes, she would submit the claim to insurance using the specific coding rules of the patient’s carrier.

Emra would know when I have three patients waiting. She would glow with orange pulsing LEDs to remind me to move along or just show a steady green when I can stay and exchange jokes. She could stay in the room after I leave, so she could help the patient to schedule follow-up appointments and share patient education material.

Emra would remind me to write a thank you note after she overhears me receive a gift from a patient.

The truth is we have the technology to create Emra today. Whatever resources it would take to develop her are small compared with the savings she would bring, the opportunity for data mining from the structure data she would collect, and the retention of doctors and staff who today are simply worn down by the current state of EMR. Until then, I’ll have to enjoy my wife’s chocolate chip cookies.

Disclosure: Hovanesian reports he is a shareholder of Amazon.com Inc.