Electronic Health Records (EHRs) are generally viewed by clinicians as a technology that requires a lot of effort without providing much reward. Crucial information is scattered, and users spend far too much time trying to find it. Too often, they simply give up. Documentation is a separate task, as is checking off requirements for quality measures. And now, with increasing pressure to produce interdisciplinary care plans, share information with patients, and meet additional quality and documentation requirements, the soul-crushing focus on the care and feeding of the EHR is interfering with patient care.
We have reached the point of “the tail wagging the dog.”
The unfortunate truth is that rather than providing the information clinicians need to care for the patient, we are forcing them to focus on the technology itself. Now consider the alternative: What if the EHR pushed relevant information to the user, rather than the user feeding the EHR and receiving nothing in return? In other words, what if the EHR was a tool for patient care, rather than a set of tasks primarily focused on facilitating billing processes?
Today, there is a lot of talk about “curating” data or problem lists, which present clinicians with a snapshot of a patient’s active diagnoses and key health issues. Of course, an updated problem list is a good thing, but it is only a start. With a good problem list, clinicians can access an overview of a patient’s clinical conditions, but they also need to quickly see the relevant information for that problem––including medications, critical lab results, and any requirements for documenting key indicators such as quality measures––as well as related history and physical examination findings. This requires the ability to diagnostically filter the chart, using any item from the problem list as an “index” to the rest of the patient record.
For example, selecting any problem from a problem list should instantly present the user––in a comprehensive, single-screen view–– with the following information:
- Medications being taken for that problem
- Lab orders and results that are relevant for that problem
- Therapies and other care plan items for the problem
- A filtered view of any free-text notes, such as those commonly in encounter history and physical notes, with significant items pertaining to the problem highlighted
- Relevant co-morbidities for the problem
- Clinical quality indicators or measures related to the problem, and whether they have been completed and, if not, a summary of items needed to comply with each measure
- An indicator if the problem requires any special handling, such as for risk adjustment as a hierarchical condition category (HCC) for programs such as Medicare Advantage
- If an HCC is applicable, an indicator of appropriateness of documentation and a link to the key indicators required to comply with patient care and documentation requirements
Once this information is available, it must be presented in a way that matches how clinicians think and work. Documentation should be completed as a result of caring for patients, and not as a separate task.
These baseline capabilities will transform the EHR into a tool for clinical use at the point of care. But there are additional considerations that must be part of the solution for 21st century care, including:
- Information must be able to be easily shared among all members of the care team, with role-specific views
- Data must be available for sharing with external resources, with domain-appropriate coding to standard reference terminologies including ICD10-CM, SNOMED, CPT, LOINC, RxNorm, HCPCS, and others
An EHR that is a tool for patient care, rather than a set of tasks, will provide benefits real, tangible benefits ranging from better quality of care and measurably improved patient outcomes, increased patient and physician satisfaction, and increased throughput––facilitating an increase in the number of patients treated without an increase in clinical staff.
EHR usability continues to be a major source of physician frustration––fueling burnout and detracting from quality care. The healthcare industry is late to the game when it comes to transforming EHRs from burdensome tasks to truly valuable tools that work for clinicians. Unfortunately, there are no industry-wide standards today to mandate problem list fixes that will transform the usability of EHRS.
Fortunately, solutions exist that can augment existing EHRs and enable them to provide physicians with problem-oriented views of clinically relevant information that can lead to improved clinical decision-making at the point of care. By mirroring the way clinicians think and work, these tools can help provider organizations address care gaps, meet regulatory requirements, and ensure better patient outcomes at lower cost.