Electronic Health Records are Broken, But They Might be Fixable

The director of Penn Medicine’s Center for Health Care Innovation, David Asch, MD, MBA, compares the current state of electronic health records (EHR) to the early days of film.

“When the first movies were made, they were really just plays made permanent on film. It took time before film editing and special effects turned the two dimensional images on the screen into something more immersive than what could be performed on stage,” he said in a statement supporting a new New England Journal of Medicine commentary he co-authored. “[EHRs] are still just putting plays on film.”

The analogy argues that the technology still fails to leverage all of the luxuries of modern computing. EHRs have just moved the paper chart onto a screen, but they haven’t yet integrated into a physicians’ workflow to make patient care easier—most would argue they have actually added to a doctor’s obligations.

>>READ: How Can Hospitals Make the Most of Their EMRs?

Katherine Choi, MD, and Yevgeniy Gitelman, MD, are the other 2 authors on the piece. The trio pondered the following: If people can use digital streams to constantly be in-the-know about their favorite musicians or sports teams (it’s a Penn Medicine article, so they mention the Philadelphia Eagles), why can’t physicians do the same with their patients?

They have a few examples of how Penn has implemented the concept to better track patient care. In 1 scenario, clinicians at the health system noticed that they had to manually check the EHR to see when a prescription expired. That led to about a tenth of necessary prescriptions running out without being renewed—a simple fix was to create a web application that sent push notifications to mobile devices reminding physicians to renew. The idea cut missed renewals by a third. The health system also set up alerts to remind physicians to refill parenteral nutrition orders for patients who need it.

But, as the authors write, “Alerts themselves are not new, and systems must be carefully designed to reduce the risk of alert fatigue, which can become self-defeating.” To counter that, they developed a filtering system to prioritize notifications—just the same way that consumers can set up their social feeds to see more about what they like or need to know. At Penn, they gave the clinicians the ability to select the patients or metrics that they needed to know the most about—like allowing renal doctors to only receive updates about their patients’ kidney functions, as opposed to other information that may be logged in the EHR by other clinicians in the system.

To check their work, Penn Medicine zeroed in on the 30 patients with the highest use of care in 1 of its hospitals. They monitored them with a dashboard to follow their needs, and clinicians were alerted in real time whenever one of the patients popped up in the emergency room again. That allowed them to create health action plans, which in turn cut 30-day readmissions and days in the hospital dramatically after 1 year.

The team concedes that such tools do require “a blend of programming skills and clinical sensibilities, foundational platforms and application programming interfaces providing access to real-time data, and a leadership commitment,” that some health systems might lack or even fear.

“Treating clinical data as static files to be retrieved misses opportunities to relieve physicians of outdated, unnecessary burdens,” however, and EHRs can be made better with existing methodology—it just hasn’t happened yet.

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