Electronic Health Reporter

By Christopher Maiona, M.D., SFHM, chief medical officer, PatientKeeper, Inc.

With all that the healthcare system has to worry about these days, perhaps it’s time to hit the “Pause” button on health IT deployment.

Or not.

While it’s certainly true that provider organizations can ill afford any disruption or downtime in their health IT infrastructure right now – one could argue a massive EHR replacement project might not be advisable at this moment – it’s equally true that effective, practical health IT is needed now more than ever. Clinicians on the front lines of the COVID-19 response need accurate and relevant patient data from the EHR system, instantly (meaning with one click, not dozens); and they need to be able to collaborate with their colleagues on urgent patient care issues at a moment’s notice, anytime, anywhere.

To that end, nothing could be more practical or timely amidst the COVID-19 patient surge than patient data access and care team collaboration capabilities on mobile devices. Smartphones and tablets are the information access and communication tools of choice for most clinicians, wherever they may be – within the hospital, in a triage tent, quarantined at home, or anywhere in between.

But for hospitals under the gun in the midst of this pandemic, is implementing such functionality really feasible?

Let’s back up, and consider a fundamental truth of healthcare IT: EHRs aren’t supporting doctors the way they were intended to, and are diverting valuable time that could be spent with patients.

Ironically, before the EHR, a physician’s biggest pain point was not having access to enough data.  Patient information was siloed, typically in dusty paper charts buried in the basement or out of reach in off-site storage. Physicians didn’t have a comprehensive view of the patient. Now with EHRs, providers should have better access to patient information. Alas, that often is not the case, as vital information is buried in a sea of redundant or irrelevant data within electronic clinical notes.

It is crucial that the healthcare industry empowers physicians with tools that will make them better. Unfortunately, forcing physicians to wait their turn for one of too-few hospital workstations is not making them better. The inexplicable persistence of UIs that fail to effectively parse information in a manner consistent with a physician’s workflow or thought process isn’t helping. Obtrusive, non-emergent automated queries that foster alarm fatigue aren’t helping.  System design predicated on a one-size-fits-all user experience strategy hinders delivery of care.

On the other hand, well-designed mobile apps, which afford ready and actionable access to relevant patient data, can accelerate care. And if such apps are (a) an extension of the existing EHR, and (b) as intuitive to use as any consumer app on your phone today, then training and adoption shouldn’t be a problem.

The value of “mobilizing” the hospital EHR goes far beyond effectively caring for patients under crisis conditions. It has become essential for provider collaboration on patient care generally, as physicians today are as “siloed” as patient records once were.  We are not all in the same hospital at the same time.  Remote access to records and the ability to easily communicate with each other within the context of a patient chart are key to the kind of collaboration that fosters better care.

Mobility also is a prerequisite for telemedicine. Without a mobile foundation, telemedicine would be relegated to a FaceTime conversation between doctor and patient. If it wasn’t for the initial work in simplifying the EHR on a mobile platform, the rapid scale-up of telemedicine during the COVID-19 crisis might not have been possible.  In addition, mobility affords providers an opportunity to limit unnecessary personal exposure beyond patient encounters by removing them from common spaces and shared equipment.  Following a patient encounter, a provider may review records and document the visit away from the nurse’s station, on their own tablet or phone.

We need to continue to develop mobile clinical workflow capabilities that allow us to transcend the brick and mortar confines of the legacy EHR – in the interest of safety, efficiency, and improving the quality of patient care.