The electronic health record (EHR) originally was envisioned as a means to improve clinicians’ access to patient information. Unfortunately, the EHR has been hijacked by finance and compliance functions. The result? Today's EHRs are a thorn in the side of physicians.
The root of the problem stems from the fact that nearly all EHRs currently deployed at U.S. hospitals began as systems to operate a hospital, not to support physician workflow. Over time, the hospital information system’s role expanded to include patient clinical data and physician workflow automation.
Unfortunately, the typical EHR has not yet evolved to meet physicians’ needs in an intuitive or optimal manner. AMA President David O. Barbe, M.D., recently observed, “Poorly-designed and implemented EHRs have physicians suffering from a growing sense that they are neglecting their patients and working more … as they try to keep up with an overload of type-and-click tasks.”
If EHRs truly were clinical tools, optimized for physicians, they would look, feel and operate differently. Here are six common characteristics of first-generation EHRs that ought to be consigned to the ash heap of healthcare IT history:
1) EHR-driven workflow is unfamiliar. It is dictated not by what the physician knows about treating patients and has been doing for years, but rather by the processes that exist deep inside the hospital.
2) Training is extensive. Hospital EHRs require classroom training that often takes physicians away from their patients for days. By definition, anything that requires individuals as smart and competent as physicians to spend days in training is not intuitive and is not part of their natural workflow.
3) Structure is process-centric. Physicians waste a lot of time clicking around the hospital EHR to find all the information they need about a particular patient. That’s because the data may live in multiple systems/modules, and the systems are structured in a process-centric way rather than a patient-centric way.
4) Alerts are intrusive. This issue, which is rampant today, occurs when there are so many alerts that physicians no longer pay attention to them. We have not yet found the best way to curate electronic alerts sent to physicians and have other members of the care team (pharmacists, nurses, etc.) manage the rest. Ironically, in the paper world, when getting an alert to the physician involved paging and a call back, there were fewer alerts and the percentage of those that were meaningful was much higher.
5) Notes are cluttered. In many computer systems, physicians are encouraged to dump large amounts of clinical information into their notes, providing little value for the next clinician who reads them. As a result, physicians are spending more time sifting through lengthy clinical notes trying to discern the vital nuggets of information necessary to inform the care they deliver to their patients.
6) Medication reconciliation is messy. Ensuring that patients’ medications are accurately, completely and promptly reconciled between home and hospital, and back again, can be an agonizing process for nurses and doctors.
The next-generation EHR physician experience will solve these problems and actually make it easier for doctors to do their jobs and, not coincidentally, help to improve patient care. Thankfully, new technologies are emerging that will meaningfully support providers’ clinical decision-making.
Applied artificial intelligence (AI), for example, is putting the power of “machine learning” at the forefront of care delivery. Think of Amazon’s “suggestions” when you make a purchase online – through data analytics and information technology, the site automatically makes recommendations on what additional items you may be interested in purchasing. The same concept can be applied to physicians’ orders, where AI can suggest which orders should be considered based on an analysis of treatment patterns in similar patients. At minimum, this saves providers time by putting orders a click away. In some cases, this will help avoid a missed order or delayed order that could make the difference between a great outcome and a less than ideal one.
Adaptable user interfaces also have the potential to revolutionize the way providers work. Today’s technology has the ability to tailor clinical data presentation based on a provider’s specialty, personal preferences and the patient’s situation. Highlighting the most important information saves time and reduces the chance a provider will miss an important result. This ensures timely, effective care and ultimately will improve outcomes and reduce cost.
Finally, clinical insights driven by “big data” analytics will contribute to more efficient, actionable and effective healthcare. One of the first targets for this type of effort is sepsis in the hospital environment. According to The National Institute for General Medical Sciences, severe sepsis strikes more than a million Americans every year, with an estimated 28 to 50 percent of those infected succumbing to the ailment. That accounts for more than the number of U.S. deaths from prostate cancer, breast cancer and AIDS combined. One of the biggest reasons for this high mortality rate among patients is the fact that the disease progresses rapidly and requires quick detection and intervention. With a digitized record and the constant vigilance of an inference engine, patients at risk for sepsis or in the early stages of sepsis can be identified more quickly, which will save lives.
These examples show where the EHR is headed and the promise it holds. In order to get there, however, we must first focus on humanizing the technology so it is usable by, and valuable to, physicians. Only then will EHRs become the indispensable clinical tools they ought to be.
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Paul Brient is the CEO, and Jennifer Sun, M.D., is a product manager at PatientKeeper, Inc., a provider of healthcare applications for physicians.
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