CHARTSaaS apps can create real-time EMR/EHR and cognitive support

“The major problem with EMRs, as they are conceived and as they presently exist, is that they are round pegs in square holes.  They are designed to gather and store information; shiny electronic file cabinets, and they are built around the primary function of billing; grinding out ICD-9 and CPT codes.  That would be fine if that was what doctors actually do with their time and if making money was the primary goal of practicing medicine.  However, surprise, surprise, what doctors really do is treat patients.  EMRs often hinder, not assist, the giving of medical care.

A physician’s normal function is to interface between objective biology and the complexity of each human life. Often called “the art” of medicine, it is the act of bridging science to individual reality.  Ask questions; test; collect information.  Attempt to organize by creating of a list of possibilities, a differential diagnosis.  Assimilate, screen and sift that data until you reach a final diagnosis.  Then, implement therapy using science and the results of research, with compassion, patience and the skill of a teacher.

A functional electronic health delivery system would assist in this systematic decision process, actively participating in the query and analysis, adding scientific knowledge and observations based on state-of-the art recommendations.  Help the doctor build the differential.  Recommend testing or therapeutic alternatives.  The EMR should be aligned with the doctor’s goals, which are the patient’s health …

A health computational system should have, at a minimum … Easy data entry and access. Flawless expanding storage.  Clear output.  Actionable recommendations and observations, based not only on the patient, but on the science of medicine.  An EMR should be updated continuously by clinical information such as labs, vital signs and tests, as well as the most recent scientific discoveries, even if they are made halfway around the world, delivering at the bedside the vast resources of big data.  Help me care for the patient by complementing my work.

As the practice of medicine becomes logarithmically more complex with the expanding potential of genomic or personalized medicine, advanced information technology will be vital.  No doctor will be able to assimilate an individual patient’s genome and thousands of actionable variables into a differential diagnosis or comprehensive treatment.  The key will be real-time EMR support …

This slowly expanding area of IT research is called translational bioinformatics, but there have been relatively few dollars invested by the NIH in the basic science.  Data input remains primitive.  We have no backbone on which to create a national network to maintain and track individual records.  There is no integration with decision making software or connection to research troves.  Medicine relies on the doctor to connect the myriad dots, even as he or she is up at midnight, typing elementary progress notes into elementary office systems.

Doctors need and desire help in taking care of their patients, but instead they have a tool designed for secretaries and insurance auditors.  We must readdress the goals of clinical IT to improve, empower and give medical care. The future of our patients and the future of health, depend on it.  No amount of frustration and burned out physicians will force patient lives into slots built for dollars.”

The foregoing excerpts from the November 1, 2014 article entitled Why is medical IT so bad? by  on the website ( describe succinctly the mismatch between commercial off the shelf EMR/EHR systems (e.g. — Epic, Cerner, Meditech) and the medical practice and healthcare delivery needs of physicians and their patients. However, information technology (IT) applications a.k.a. apps created using an IT solution compliant with the Cloud Healthcare Appliance Real-TIme Solution as a Service (CHARTSaaS) reference architecture (RA) can satisfy all the requirements cited by Dr. Salwitz, which he summarizes thus:  A CHARTSaaS RA-compliant solution enables healthcare provider subject matter experts (SMEs) to design, develop, deploy, operate and optimize apps with minimal cost and complexity that realize Dr. Salwitz medical care IT vision: “The key will be real-time EMR support.”


Please validate to your own satisfaction the proposition that a CHARTSaaS RA-compliant IT solution can realize Dr. Salwitz vision by reading the white paper at and then by reviewing the details of CHARTSaaS™ and the CHARTSaaS RA™ in these presentations:

Healthcare providers will benefit significantly from appreciating and then applying a CHARTSaaS RA-compliant IT solution. To do so will mitigate medical mistakes (currently the third leading cause of patient deaths. per Makaray and Daniel (re; thereby minimizing patient adverse events and optimizing clinical case outcomes while maximizing the cost-effectiveness of care and treatment, and also accelerating the accrual and facilitating the application of medical knowledge.

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