Jonathan Bush: EHRs should give physicians what they need, not burn them out — So I'm deconstructing it

Athenahealth co-founder and CEO Jonathan Bush thinks the healthcare technology industry should do more to improve physician satisfaction and fight tech-induced burnout, both of which entail reimagining his company's products.

Mr. Bush doesn't like the current EHR functionality. For him, the ideal EHR would be comprised of several, self-contained, high-speed microservices that would take the highest traffic parts of a medical record and run them as a concentrated focus factory. In other words, athenahealth is replatforming, rewriting and breaking down the EHR into what Mr. Bush said it should have been in the first place: a series of untethered microservices, he told Becker's Hospital Review in a March interview.

He believes this could reduce physician burnout, advance interoperability and empower patients — ideas he reiterated in a May 8 opinion piece for STAT.

"Over the past year, I set my research team loose on aggregated data of the day-to-day clinical and financial activities logged by more than 111,000 doctors and their organizations who are using athenahealth’s cloud-based platform in order to investigate what causes — and cures — physician burnout and what can be done at the organization level to put patient care back at the center of physicians' jobs," he wrote.

What his team learned is that EHRs aren't giving physicians the tools and support they need to best serve their patients.

Physicians who felt supported were more productive, less likely to leave their organizations and less likely to show signs of burnout, according to an athenahealth survey. "This suggests that, as an industry, we must go beyond piecemeal interventions that treat symptoms instead of causes, or are designed to help doctors adjust to a status quo that is clearly unsustainable," Mr. Bush wrote. "Instead, we must radically redesign doctors'  jobs to restore the primacy of the physician-patient relationship."

So, the company embarked on an effort to overhaul itself, he told Becker's in March. He envisions an EHR that has been deconstructed into a series of unbundled services that organizations would individually subscribe to, similar to how other technologies work in different industries. He pointed to Amazon as an example — Amazon is subdivided into separate service businesses like cloud with Amazon Web Services, e-commerce with Amazon Prime and home with Alexa.

Imagine a free mobile app, Mr. Bush told Becker's, that is built in an application programming interface-first, open way. That app doesn't have a patient directory, reporting or other features: It is only able to look at a patient's chart.

"What we hope is other people will plug into that app foundry and build other apps to look at that data," Mr. Bush said. "We open ourselves up to the ecosystem of many different information utilities, not just the ones we built ourselves."

One of those microservices could be artificial intelligence, which he thinks shows the most promise in alleviating menial, time-consuming tasks like sorting through faxes. Mr. Bush also wants to dispel the notion that a hospital's data should only belong to that entity: Instead, all patient data should pool together and form a large data repository.

"To support providers in the moments of care, we need to infuse their workdays and workflows with the same kind of consumer-grade user experiences they enjoy in the rest of their lives," he wrote in STAT. "This means liberating them from [EHRs] that require 4,000 clicks while easing their documentation burden with smart voice assistance and machine learning."

More articles on EHRs:
Physicians were burnt out long before EHRs, according to this 2002 report
U.S. physicians' notes 4x as long as those of physicians overseas: 3 things to know
How Google is using deep learning to understand EHR data and reduce readmissions

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