Physicians have never been terribly happy with EHRs, most of which have done little to meet the lofty clinical goals set forth by healthcare leaders. Despite the fact that EHRs have been a fact of life in medicine for nearly a decade, health IT leaders don’t seem to have figured out how to build a significantly better one — or even what “better” means.
While there has been the occasional project leveraging big data from EHRs to improve care processes, little has been done that makes it simple for physicians to benefit from these insights on a day-to-day basis. Not only that, while EHRs may have become more usable over time, they still don’t present patient data in an intuitive manner.
However, hospital leaders have may be developing a more-focused idea of how a next-gen EHR should work, at least if recent efforts by Stanford Medicine and Penn Medicine are any indication.
For example, Stanford has developed a next-gen EHR model which it argues could be rolled out within the next 10 years. The idea behind the model would be that clinicians and other healthcare professions would simply take care of patients, with information flowing automatically to all relevant parties, including payers, hospitals, physicians and patients. Its vision seems far less superficial than much of the EHR innovation happy talk we’ve seen in the past.
For example, in this model, an automated physician’s assistant would “listen” to interactions between doctors and patients and analyze what was said. The assistant would then record all relevant information in the physical exam section of the chart, sorting it based on what was said in the room and what verbal cues clinicians provided.
Another initiative comes from Penn Medicine, where leaders are working to transform EHRs into more streamlined, interactive tools which make clinical work easier and drive best outcomes. Again, while many hospitals and health centers have talked a good game on this front, Penn seems to be particularly serious about making EHRs valuable. “We are approaching this endeavor as if it were building a new clinical facility, laboratory or training program,” said University of Pennsylvania Health System CEO Ralph Muller in a prepared statement.
Penn hasn’t gone into many specifics as to what its next-gen EHR would look like, but in its recent statement, it provided a few hints. These included the suggestion that they should allow doctors to “subscribe” to patients’ clinical information to get real-time updates when action is required, something along the lines of what social media networks already do with feeds and notifications.
Of course, there’s a huge gap between visions and practical EHR limitations. And there’s obviously a lot of ways in which the same general goals can be met. For example, another way to talk about the same issues comes from HIT superstar Dr. John Halamka, chief information officer of the Beth Israel Deaconess Medical Center and CIO and dean for technology at Harvard Medical School.
In a blog post looking at the shift to EHR 2.0, Halamka argues for the development of a new Care Management Medical Record which enrolls patients in protocols based on conditions then ensures that they get recommended services. He also argues that EHRs should be seen as flexible platforms upon which entrepreneurs can create add-on functionality, something like apps that rest on top of mobile operating systems.
My gut feeling is that all told, we are seeing from real progress here, and that particularly given the emergence of more mature AI tools, a more-flexible EHR demanding far less physician involvement will come together. However, it’s worth noting that the Stanford researchers are looking at a 10-year timeline. To me, it seems unlikely that things will move along any faster than that.