On ease of use
Modern Healthcare: A huge issue today is the usability of electronic health records. How easy are they for physicians? For nurses? It’s causing burnout. What are you doing at the system level to make EHRs easier to use by frontline healthcare workers?
Dr. John Halamka:
If you were to talk to Judy Faulkner (CEO of Epic Systems Corp.) or Neal Patterson (CEO of Cerner Corp.) or Howard Messing (CEO of Meditech) or any of the CEOs about their development pipeline, they must address regulatory compliance before they can address usability. We perfectly engineered exactly what we have: highly compliant, data-collection systems that are very challenging to use.
What have we done? You’ll hear a lot at this conference about FHIR (the Fast Healthcare Interoperability Resources data exchange framework) and various kinds of interoperability. We are surrounding the electronic health record with thirdparty modules that are adjuncts to these transactional compliance and regulatory systems that are much more pleasing to use.
We use Apple products and send data to your phone. We use things like doctors and nurses developing workflow tools that meet their needs that connect to our EHR. I think we’ll see over the next couple of years an ecosystem of external apps, not authored by the EHR companies, that accelerate usability.
It’s going to be third-party applications. We’re going to have to be able to create some kind of middle layer that uses these applications quickly and easily. But what are we doing today? We’re working within the boundaries that have been created by our vendor. We’re doing as much as we can to tailor those systems to make documentation easier, but I don’t think we’ve succeeded.
We’re seeing some of the same things. At Baylor Scott & White, a very physician-led organization, we’re talking about restoring the majority of practice back to physicians. It’s a physician-led effort and they’re actually looking at workflow and how much they have to do.
These are transactional systems that are made for regulatory compliance. They’re not workflow enablers. They are checking a box and going through all of the different things you have to do for meaningful use. Most of them started out for capturing charges, right? They weren’t really thought about for care. They were thought about for billing. We’re unique in healthcare in that we take the most expensive, critical, human element of the value creation chain and we make them do all the data entry.
MH: There are two possibilities you’ve raised. One is re-engineering the workflow to accommodate the EHR. Or you can do bolt-ons —develop new technologies. Which is the more productive path?
Halamka: The answer is both. I’m an emergency physician. The emergency physicians of Beth Israel Deaconess used to see 2.5 patients per hour because of the burden of electronic health record data entry. We hired $30,000-a-year scribes to follow the emergency physicians and made them twice as productive. It’s not elegant. But as a short-term fix, it enables you to return to the joy of practice and practice at the top of your license by doing a few of these interventions simultaneously.
Chambers: What we hope to create in the next couple of years is the best user experiences and the best user interfaces. They should be invisible. If you don’t have to think about how to interact with it, and you just interact with it, then it’s the best ever. We are betting the farm on making the interface go away. Let the physician talk with natural language processing. That’s where we think it needs to go because the regulatory issues are never going away. The documentation issues are never going away.
Probst: I’m a little bit more hopeful that the regulatory issues will start to go away.
Chambers: You spend a lot more time in D.C.
Probst: These systems are old. They were built for something other than clinical documentation, patient flow and physician use. It’s going to be really hard for us to get over that, particularly since we’ve spent $35 billion installing these systems over the past several years.
Hopefully, there are some really smart minds building new applications that are going to replace these EHRs of today. Hopefully our current vendors are thinking about it. If regulatory issues go down, it’ll open up a lot of creativity and opportunity to do it better.
If you don’t have to think about how to interact with it, and you just interact with it, then it’s the best ever. We are betting the farm on making the interface go away.
Dr. John Halamka