CMIO musings: The ideal EMR — A wish list

The EMR has been both a blessing and a curse. It does offer some conveniences, such as remote charting and automation of some workflows, however, it's another piece of healthcare technology that, for the most part, has not taken the end user into account. This causes distractions for all healthcare workers and it can reduce the important rapport-building with patients.

In its current form, the traditional EMR has been clunky and difficult to use. It requires a lot of clicks to get the end user where they want to go, and a number of potentially helpful applications can't always leverage the data inside the EMR to deliver the most optimal results.

For example, when you compare the current industry-standard EMRs to Google, which pulls together data from across the internet, it becomes obvious how behind the times healthcare IT products are. Both the Google suite of applications and many EMRs are modular, yet the user experience is completely different.

The EMR consists of a number of programs that aren't always integrated. It is a conglomeration of apps strewn together and a diverse series of login credentials. Moreover, in one facility, there may be multiple EMRs targeting different departments.

With Google, I can seamlessly go between my email, the internet to find Indian food and directions to the restaurant, YouTube to watch videos and all my photos — without ever having read an instruction book or attended training.

Let's just say the traditional EMR system doesn't have the same level of imagination.

Rethinking the EMR

A successful EMR combines operations — clinical, financial, etc. — during the IT design, not after. The most successful vendors already do this by keeping the physician top of mind when building their products because the physician workflow affects so much of hospital operations.

However, vendors should solicit input from all end users — including nurses and pharmacy staff — at all levels of product development. The most successful vendors also involve the hospital's IT team. That way, the IT department understands clinicians' workflows and how they want to interact with the EMR.

But, the onus isn't solely on EMR vendors: Healthcare organizations must also step up to the plate if they want to see positive changes in the EMR space. A hospital system that considers the EMR as simply an IT product instead of an operations product — with the proper resource allocation — is setting itself up for failure.

An EMR wish list

Here are six things all EMR vendors should consider incorporating into their software.

1. The EMR should understand the data it stores. Data governance is often a second thought creating many issues. Data entry is one of physicians' and nurses' top pain points in regards to the EMR — but it doesn't have to be. Automating processes and assisting clinical personnel better would lead to a more user-friendly EMR. However, the EMR must go one step further to be as intuitive as physicians need; in order to reap its full benefits, better data integration is a necessity. This means the EMR should be capable of analyzing patient data to identify patterns or gaps in care, as well as predicting outcomes or advising treatment plans. It should also be able to take in patient generated health data to paint a clearer picture of individuals' unique health circumstances. Think of it this way — Google and Amazon, for better or worse, often know what your preferences are before you do. The EMR should get to this level.

2. It should be wholly interoperable. An EMR that can connect all of an organization's departmental EMRs and enable cross-organization communication and collaboration is a must. This data sharing should extend beyond the four walls of each individual organization. The U.S. healthcare industry has been grappling with this idea of connectivity, or interoperability, for years. But, in the mobile age we live in, in which people are constantly moving from place to place, all of healthcare begs for interoperable technology systems. In other words, it may be time to put patient needs ahead of our business desires as this is effectively a patient safety and healthcare waste issue.

3. Machine learning and artificial intelligence capabilities should address various hospital needs, including infrastructure and population health concepts. For example, given our current abilities, we should be able to improve our staffing in the emergency department using predictive analytics based on historical information regarding weather patterns, time of year, activities in a city and more. We can even better equip the EMR with various AI capabilities that could help ease some of the data entry burdens, provide better decision support and improve patient outcomes. For example, alert fatigue is a significant barrier. AI could provide better decision support and a more "intelligent" option for alerts to direct appropriate physician decision making rather than the current shotgun approach. Furthermore, an EMR that features voice recognition or auto-population — similar to Amazon's or Google's search functions — would drastically decrease the time it takes physicians to complete notes, and various decision support tools could ease diagnostic, regulatory and coding issues. Algorithms could also improve scheduling and staffing needs, as many organizations' current scheduling processes fail to consider factors that may drive more patient visits, such as the aforementioned weather or special events in the area. From a population health standpoint, one example is that an EMR with AI could potentially identify specific factors that are affecting a subpopulation of patients with diabetes and provide more targeted treatments rather than just what the standard guidelines may indicate, or it could identify better suicide risk factors and provide treatment suggestions before it is too late.

4. Cloud storage is a plus. The cloud is nothing new — it's been used to store emails and files for years — and only shows signs of expanding, which is why it's time to start hosting health data on it. Not only is it cheaper, but it can enhance security, convenience and accessibility. Cloud vendors often have many more resources to expend on cloud technology, and outsourcing data hosting to a cloud vendor opens up valuable hospital IT resources. While organizations considering a move to the cloud often fear they'll give up control of the data to cloud vendors, it's not always the case. In fact, if all vendors hosted on the cloud — which is known for its scalability — organizations would be able to pool data from multiple hospital organizations to create true population health and precision medicine. However, this would obviously require some additional steps for matching the data fields.

5. Open notes would ensure stronger patient-physician relationships. Given the CMS ruling, patients own their data — and that is to everyone's advantage! Giving patients full access to their EMR not only empowers them, but it also engages them in their care. An EMR that enables easy patient access and data entry would lay the groundwork for stronger patient-physician relationships by establishing patients' trust and building greater interest in their health. Of course, caution should be taken here, such as in cases of mental health or domestic abuse, to protect individuals and ensure they are being kept as safe as possible.

6. The EMR should incorporate patient-generated data. The wave of the future is the patient biometric devices that can give us much more and much richer insights into patients' whole health. For example, we used to diagnose and treat hypertension on just a few readings every few months. Now we can have real-time data. This allows us to  improve treatment, as well as reduce overtreatment, which is equally dangerous. Reviewing patient generated data, like that from a Fitbit, also shows what aspects of patients' care plans need to be refined. The step count on a Fitbit could indicate a patient's need to exercise more or that they need to switch up their workout regime. Moreover, the Apple Watch shows promise of identifying irregular heart rhythms, like atrial fibrillation.

The EMR of the future should function the way Amazon, Google and others work — be able to take data and turn it into meaningful and actionable knowledge in an intuitive and enjoyable method. This vision is not asking too much when we see the other IT products out there. Healthcare needs to get into the 21st century!

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