When it comes to a physician’s medical records, it truly does not matter whether an EMR is intended for a single doctor practice, small group, large group or large network of physicians. The physician's workflow is the same by specialty whether the physician is part of a small or large group.

Perhaps the ancillary applications are pertinent to the size of the group, but not what the physician does during a doctor/patient encounter. The physician's medical records are truly the core engine that drives healthcare. The physician only requires proper patient identification to perform and document a patient visit. Once the patient is accurately identified, the doctor’s workflow and normal descriptions are the same for every patient of the same gender by specialty, regardless of the size of the provider group.

The Physician's Electronic Record consists of the following: Chief Complaint, History of Present Illness, Medications, Allergies, Review of Systems, Past Medical History, Family History, Social History, Vital Signs, Physical Examination, Diagnoses and Recommendations. 

In the case of a specialist, the Physical Examination may include diagnostic procedures such as a nasopharyngoscopy for an ENT or a Pulmonary Function Test for a Pulmonologist. Furthermore the workflow by specialty is the same regardless of the location where the care is provided. In other words, an ENT's workflow is the same in a small or large group of providers as well as in the office or hospital setting. In essence, the Physicians Electronic Records is at the core of any EMR and thereby the engine that drives healthcare.

Only when a physician performs the complete history detailed above will the engine start working. The physicians' recommendations feed the Computerized Physicians Order Entry (CPOE). There is no need for the physician to manually enter any orders into a CPOE system. All physicians' recommendations fall into one of these categories: Diet, Activity, Labs, Radiology, Special Diagnostic Studies, Medications, Therapy, Consultations, Surgical Procedures and Follow-Up Visit. Only after the physician has made the recommendations does healthcare start to take place.

Physicians of the same specialty have the same workflow with the exception of certain procedures that some specialists may choose to perform or not. For example, an OB-Gyn may or may not deliver babies. If he or she does not, then this particular part of the workflow will default to ‘omit.’ Furthermore, the description of the normal findings by specialty is also the same by gender.

How a urologist describes the normal findings for a male GU system is the same for all males. Only the abnormal findings change from patient to patient and even then the description of the abnormal findings also becomes redundant. For example, a cardiologist may describe a Mitral Valve Prolapse Murmur as a "systolic murmur, Grade II/VI at the apex" or an Atrial Fibrillation arrhythmia as "an irregularly irregular rhythm". Even these abnormal descriptions can be standardized in pull down pick lists to avoid repetitious documentation.

Therefore, by standardizing the workflow by specialty -- standardizing the normal descriptions or normenclature as well as the abnormal findings in drop down pick lists -- the Physician's Electronic Records portion of the EMR will greatly eliminate repetition and save the physician about 80% of their day-to-day documentation. This is true regardless of the size of the group or the facility where the care is taking place.  

Now, provide this standardized, normalized application to a physician in a mobile device such as the iPad for Free and doctors will be sign up by the droves. So, how then will an EMR vendor make money? The answer is by the transaction.

Each patient encounter will generate an average of five to six transactions or more: the medical note, two e-prescriptions sent to the pharmacy, one billing transaction and diagnostic study and a follow up visit. If a physician pays twenty-five cents per transaction, then each patient encounter will generate an average of $1.25 to $1.50 per patient visit for ambulatory outpatient visits as well as in-patient visits.

According to the CDC, in 2009 there were 956 Million physician office visits. The advantages for the physician to pay as you go means no upfront money out of pocket, a Physician's Electronic Record that runs on a mobile device such as the iPad and a database that resides in the cloud such as Google. The patients’ medical records are with the physician wherever he or she goes in a HIPAA compliant environment that is never down. It can't get any better than that.