EHRs at risk of becoming irrelevant

'In many ways the EHRs are on the outside'
By Eric Wicklund
10:00 AM
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Andrew Watson

With mHealth becoming the norm instead of the exception, a panel at Partners HealthCare's 10th Annual Connected Health Symposium last week concluded that EHR vendors will have to find a way to modify their products to focus on data that the patient and his or her care team want, or they'll become obsolete.

Important information for a patient's care actually exists outside the electronic medical record, panelists said.

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"In many ways the EHRs are on the outside," said Andrew Watson, MD, medical director for the Center for Connected Medicine at the University of Pittsburgh Medical Center and the panel's moderator. "This is on the inside. It's not the paranormal … any more – it's the normal."

The session, one of the first during the two-day summit at the Seaport World Trade Center in Boston, focused on what Watson termed the "para-EHR," which he defined as all of the phone calls, texts, e-mails and other doctor-doctor and doctor-patient communications that aren't entered into the EHR. They could include everything from Skype chats between doctors to Post-It notes to data residing on mobile devices and sensors.

Watson, who's also a colorectal surgeon at UPMC, estimated that 70 percent of his work with patients is conducted in that informal region outside the EHR. His fellow panelists put that number closer to 90 percent.

"The systems that we have today are not geared toward clinical efficiency," said Rasu Shrestha, MD, UPMC's vice president of medical information technology, who said EHRs are instead geared toward billing. He called the para-EHR "this other bucket of information" that more closely resembles the doctor-patient encounter.

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"Whatever it is today, it's going to get bigger," added Kent Gale, founder and chairman of KLAS.

Watson and his colleagues – who also included Eleanor Chye, assistant vice president of AT&T's ForHealth department, laid the blame for this disconnect squarely on the shoulders of modern technology. The ability to communicate and capture data in real time through mobile devices and wearable sensors, they said, has made the typical EHR obsolete.

"When the digital age collided with healthcare, which I think was around 2007, healthcare stumbled heavily," Watson said. Shrestha added: 'We focused on where the money was as we moved from analog to digital."

Chye said the healthcare industry's efforts to catch up aren't having the desired effect. Meaningful use, she said, "has created a big, sucking sound and taken all the air out of the room."

The true patient record lies in the margins outside the EHR, and contains "data that would save a patient's life," Shrestha pointed out. When prodded by Watson, the audience agreed. One person pointed out that there is no place in the EHR for the patient's story, while another questioned whether the electronic health record should be organized like a Wiki page.

"I don't think that any single EHR can humanly tackle this," Watson said.

"I do think there is a burning need to focus back on the PHR," Shrestha said, pointing out that those records contain all the information important to the patient – and nothing more. 'You don't want to be inundated with data back to the point where it's noise," he added.

Chye said EHR vendors have to decide whether to build out to capture that data or encourage innovation outside the EHR. In addition, she pointed out, should all of that unfiltered information be given to the patient?

'If it's there, it ultimately will be discoverable, and it ultimately will be pursued," said Gale, who offered that EHRs are currently designed to be provider-centric, rather than patient-centric.

And in a system rapidly moving toward patient-centered healthcare, he added, that's not a good business plan.