On ease of use

Modern Healthcare - - NEWS -

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.

Marc Probst:

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.

Matthew Cham­bers:

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

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.