Electronic Health Reporter

Guest post by Michael Sherling, MD, MBA, co-founder and chief medical officer, Modernizing Medicine.

At most hospitals and academic medical centers, physicians come together once a month to learn new approaches to treatment, to exchange ideas and to debate the possibilities of a challenging diagnosis. We call this Grand Rounds.

Grand Rounds keeps physicians up to date and helps patients too. Instead of relying on one doctor’s opinion, patients get a collective experience of several doctors. Through open debate, a more thoughtful approach to disease treatment is generated. Unfortunately, 80 percent of physicians do not practice in a hospital or academic medical center where Grand Rounds happen.[1] They practice in private practice. While there are opportunities for physicians in private practice to maintain continuing medical education through journals, online courses and annual meetings, most of these practitioners are on their own, so to speak.

When physicians in private practice see a challenging case, they can read about it in a medical textbook, phone a friend (another specialist) or refer the patient to another physician. They don’t have the luxury of calling a “time out” and presenting the case to five other physicians. Pressured by time constraints of increased documentation and decreasing reimbursement, many doctors opt to refer out the more challenging cases, or shy away from newer treatments simply because they don’t have the same access or shared experiences as doctors practicing in hospitals and academic medical centers.

Today, innovative cloud-based electronic health record (EHR) systems can present an opportunity to break down the barriers in private practice so that physicians can make more informed decisions at the point of care. Cloud-based systems rely on one instance of the software where all de-identified medical data is stored. These systems are HIPAA compliant and patient information is protected and secured. Yet, to advance medicine and improve healthcare outcomes for patients and physicians alike, the cloud-based systems can provide physicians access to de-identified patient data. Instead of relying on underpowered clinical control trials for common diseases, outdated studies for rare diseases and anecdotal evidence for orphan diseases, cloud based systems can reveal to physicians which treatment patterns are used for any given disease.

With EHR systems in more than 50 percent of physician offices across the country, patient data is already being documented on an enormous scale. [2] Unfortunately, most of this information cannot help doctors and patients because most EHR systems are unstructured and function more like word processors. It is hard to glean the clinical pearls of wisdom if they are trapped in a three-page narrative in a patient record. Newer generation electronic records are taking the long-term view and organizing the user interface in a more structured way that lends itself to extraction of meaningful medical trends and patterns.

For example, instead of relying on any one physician’s descriptive assessment of how a patient condition is doing, some systems employs standardized static global assessments that academic researchers and pharmaceutical companies use for clinical trials and post-marketing surveillance studies. If all physicians using these platform can speak the same language, meaning one doctor’s “better” assessment is the same as another doctor’s, then the software can aggregate the data and give new insights to disease treatment on a population level. Instead of private practice being shut out, they can have the grandest rounds of all, one for the entire country. And instead of relying on the anecdotal experience of other physicians, they can rely on real-world evidence with patients like their own in private practice settings.

Today, a significant amount of funding goes into clinical trials that only look at a handful of diseases and drugs and in very carefully selected patient groups. While tremendously powerful, these clinical trials are limited by sample size and cost, and the data may not be applicable to many patients in the real world. The controlled clinical trial setting is not how real doctors treat real patients. By empowering individual doctors as investigators, we can collect, aggregate and analyze hundreds of thousands of cases, so that we can understand each disease’s most effective, successful and even cost effective treatment course.

Translating this potential into reality requires changes on many levels including technology and physician education. While there are virtually thousands of EHR systems currently on the market, most are built primarily for data storage and are unable to collect patient data in a structured manner. An EHR system that is highly intuitive and built to support structured data is essential to enable wide-reaching virtual grand rounds and sharing of treatments and outcomes.

Along with the technology to support this innovative model, physician education will be essential to boost adoption and build a network significant enough to compile rich data sets. It is also important to note that data by itself doesn’t do anything; you need a community of physicians, scientists and researchers to transform data into wisdom and elevate grand rounds to its fullest potential by pooling the resources of providers nationwide. By rethinking the patient visit to visualize treatment data at the point of care using a highly intuitive EHR system, physicians can make more effective decisions. In real time, a provider can see their treatment profile for any given disease and see how it compares to the patterns of their colleagues in their practice and their peers nationally. This creates a national standard of care to improve medical compliance and decision-making. With this new grand rounds paradigm, there is potential for massive increases in efficiency, improvements in patient outcomes and even health cost reductions.