Electronic Health Reporter

Guest post by Matthew Douglass, co-founder, SVP Customer Experience, Practice Fusion

In part 1 of this series, we reviewed the history of digital health tools and discussed why they are not yet fully satisfying the needs of many physicians.

If you think of the U.S. healthcare system as a vast nationwide transportation network, current electronic health record (EHR) functionality is the basic highway infrastructure. The American Recovery and Reinvestment Act of 2009 provided the incentives for those highways to be built and put in place the structure for ONC-certified EHRs to define the rules of the road via regulatory standards. The roads are now mostly in place: certified EHRs all offer roughly the same base functionality for use by physicians, store clinical information in standardized ways, and have the capabilities to securely communicate with each other.

Sixty-seven percent of medical practices in the U.S. are now using EHRs to run all or part of their daily operations. Patients’ vital signs are stored as discrete values for each visit. Encrypted messages between physicians and their staff are transmitted reliably. Chart notes are being digitally documented and can be shared confidentially with patients. Physicians that have chosen cloud-based EHRs can securely prescribe and refill medications from the convenience of their mobile phones.

Despite having this digital highway system in place, we haven’t yet reached a destination where use of EHRs achieves better patient outcomes or improved clinical experiences. Physicians want more from digital tools than simply receiving, storing, and displaying data values about each patient visit. Rather than devoting too much of their already limited time to data entry and retrieval, physicians want to provide the best patient care possible, and they expect technology to help them achieve this goal.

There is such a thing as too much data, which physicians are reminded of each time they open a digital chart. Clinicians very often are left swimming in more data than they can adequately process, which can erode the crucial patient-provider human relationship.

To address data overload and dehumanization challenges, software partners must go back to the drawing board and visualize dramatic innovations that can be built on top of the nationwide EHR foundation. Significant cognitive overhead is required to distill hundreds of disparate pieces of clinical data into a salient picture of an individual’s overall health. The vast amount of data now available in a patient’s chart is quite often far more than any medical professional, no matter how clinically experienced, can consistently and reliably assimilate.

Physicians and their staff need intuitive technology to be their always-available, intelligent assistant, from start to finish during a patient’s visit.

When a patient’s record is displayed on the computer screen, physicians shouldn’t have to dig for relevant information about that visit. Instead, the EHR should be able to display the pertinent clinical data and health insights for the physician to review and assess a patient’s health condition more quickly and effectively. For example, lab values and vital signs relevant to that patient’s chief complaint are likely already stored as discrete values in the patient’s chart. An EHR that learns along with the physician’s workflow preferences should display only the most relevant data through easily digestible visualizations.

Documentation Overload Must Shift from the Physician to Tools

Technology exists today to process a person’s voice, parse those words, and store the text as digital documentation. Many physicians already utilize voice dictation software in their practice, but it is clunky and very often requires double-checking. More importantly, digital voice dictation is a technology that is still in its infancy and serves as a scribe for the physician without necessarily adding significant value to help streamline clinicians’ workflow and patient care.

Imagine taking this basic functionality and augmenting it with artificial intelligence: A doctor says to a patient, “I’m going to order a CBC panel for you.” The EHR then automatically parses that statement, stores it in the SOAP note as it does today, but then also queues up a standard CBC panel and prepares the order for submission to the patient’s preferred laboratory. Next, imagine that intelligent application being used for medication instructions spoken aloud: an electronic prescription could be ready to send to the patient’s preferred pharmacy without arduous typing and endless searching. At the end of a visit, all of these items could be displayed in a structured, visually-pleasing, easy-to-comprehend format for the physician to review with the patient and approve with a single click or verbal command. In seven minutes with the patient in the exam room, the physician could spend 6 minutes speaking with the patient and only one looking directly at the computer.

Smart assignment of tasks throughout the patient visit workflow is automatable and, with enough data history representing a physician’s preferred workflow, this process can be learned and implemented through intelligent algorithms that securely and safely:

• Receive as inputs all the traits and clinical history of a particular patient
• Compare values to outcomes for a cohort of similar patients
• Suggest standard evidence-based treatment options
• Recommend a potential clinical trial based on diagnoses, previous treatments, demographics, location, and other pertinent traits

AI in the medical practice all may seem far into the future, but tangible progress has already been made. One study has shown that machine learning algorithms can more readily anticipate suicide risks than clinicians on their own. Moreover, advanced image processing combined with deep learning can help pathologists be better at detecting tumors earlier. Purpose-built apps are even helping couples with their family planning.

These are but a few examples of what is possible for the future of digital clinical health tools. It is now the responsibility of physicians and forward-looking technology partners to work together in pursuit of a more efficient healthcare system that reinvigorates the humanity of patient care and improves the lives of physicians and their patients. To paraphrase the prominent futurist, William Gibson, the future of medical technology is already here — it’s just not broadly implemented in the EHR yet.