We should be in the midst of the gilded age of healthcare IT.
The stage is perfectly set to deliver on the promise our industry holds. After all, during the past few years, the healthcare industry has put a strong emphasis on quality and efficiency. A collective sense of urgency exists because of the financial realities of continued downward pressures on reimbursements and new quality-oriented incentives. Further, the need for data sharing grows with each Accountable Care Organization (ACO) that is formed and each provider group that is merged into a larger care delivery organization.
Yet, praise for healthcare IT systems is few and far between. Success stories are rare. What gives?
Of course, common scapegoats are perceived failings of Electronic Health Records (EHRs) and the federal government’s $22 billion program to drive the adoption of EHRs. Widespread disappointment for EHRs is well documented. Many clinicians point to lost productivity and awkward changes to workflow since adopting these electronic systems. Some studies suggest that up to 80% of clinicians dislike their EHR.
While these systems are far from perfect, after some reflection, I believe they are a step in the right direction and an important foundation to build upon.
In my opinion, the real dirty little secret in the healthcare IT industry is dirty data. Even the most modern systems are useless without clean, structured, actionable information.
Dirty data is caused by a many things, but most often, it is the result of awkward designs in with the way physicians are expected to document care. Some of the most popular EHRs were developed using technology that was invented in the 1960s. These “one size fits all” systems aren’t well suited to individual workflows and they lack personalization.
Clinical documentation often gets worse in EHRs because they can be awkward to use and often do not match the doctors’ preferred workflow. This often forces clinicians to skip certain steps or write clinical narratives in the “catch all” section where the information is unstructured and un-mineable. This defeats the purpose of electronic systems, and even worse, the extra time spent documenting is also time away from the patient, hindering the patient-provider relationship and causing dissatisfaction. According to a survey by Medical Economics Magazine, 45% of physicians felt that EHRs were making patient care worse. That’s frightening!
Desperate for solutions, some hospitals hire additional staff just to insulate physicians from EHRs. These so-called “medical scribes” are typically non-clinically-trained individuals who join the physician in the exam room and document on behalf of the physician. (Physicians still review and sign the note.) While scribes reduce frustration and -- in some instances -- can help physicians see more patients, scribes represent an additional cost, and the documentation often becomes even worse. In fact, in the interest of saving time, many scribes are trained to bypass the EHR's section and document solely in the comments field. In my opinion, scribes only serve to compound the problem of dirty data.
So what is the solution?
Some scholarly work at the University of Maryland may hold a clue. Professor Philip Resnik conducted an exercise interpreting physician’s notes. Traditional documentation and notes from a “modern” EHR were reveiwed. Perhaps not surprisingly, traditional handwritten notes were more helpful and accurate in detailing the patient’s case than the EHR. The original work product contained more details and clinical richness.
As an industry, we need products that amplify what works in healthcare and focus on enhancing current workflows -- not hinder them. Healthcare has always been about the relationship between a doctor and the patient. Today, we have finally technologies (mobile, cloud, and personalization) to address the challenges of today by building on the wisdom of the past.