Physicians dream up a better EHR

When the American Medical Association (AMA) last year announced study results that found physicians spend nearly half their office day entering data into electronic health records (EHRs) and handling other administrative deskwork, the organization said poorly designed EHRs were part of the problem.

“If you were to start from scratch, you wouldn’t come up with the systems we have today,” said Jesse M. Ehrenfeld, MD, MPH, an associate professor of anesthesiology, surgery, biomedical informatics and health policy at Vanderbilt University School of Medicine who was elected to the American Medical Association Board of Trustees in 2014.

The AMA developed a list of eight items it believes vendors need to improve or develop to make EHRs better for physicians and their staff.

The list starts by saying systems should

1.     enhance physicians’ ability to provide high-quality patient care;

2.     support team-based care; and

3.     promote care coordination.

The AMA also asks vendors to

4.     offer product modularity and configurability;

5.     reduce cognitive workload;

6.     promote data liquidity;

7.     facilitate digital and mobile patient engagement; and

8.     expedite user input into product design and post-implementation feedback.

“If all vendors took these to heart, things would really improve,” Ehrenfeld said. “We want tools that help us provide high quality care and make the process of care easier and more efficient. Mobile technologies, voice recognition, imaging and sensing are all things we see in the world around us, but we don’t see that happening in the EHR space yet.”

Next: Six ways EHRs could dramatically change how medicine is practiced

Every physician likely has his or her own thoughts about how to improve EHRs. Ehrenfeld and others offered several additional ideas, from practical improvements to solve today’s problems to visionary suggestions that could dramatically change how they practice:

• Make the systems work together. “I hear almost every day some issue around interoperability from doctors -- not having access to data, or if they get it, they get a 20-page document that the system doesn’t understand,” said Steven E. Waldren, MD, director of the American Academy of Family Physicians’ Center for Health IT.

• Make it easier and more intuitive. “Information is too difficult to find and the software is not intuitive,” said Derek Kosiorek, CPEHR, CPHIT, principal consultant at the Medical Group Management Association Healthcare Consulting Group. This goes to the point of the AMA study that finds doctors spending too much time interacting with computers rather than patients. For example, Marc D. Price, DO, with Family Medicine of Malta in New York State, said he must call customer support to produce certain regulatory-required reports and often needs to enter the same data multiple times. “I do duplicity work throughout the day that I shouldn’t have to do,” he said.

• Add better analytics. As the healthcare industry transitions to value-based care, physicians need to analyze their records to identify which patients aren’t doing as well as they should. Waldren said EHRs must add more robust analytic capabilities so physicians can do risk-stratified care management and drill down into dashboards to see how populations are doing.

• Support high-tech care delivery. Value-based care also will make telemedicine and remote patient monitoring more common, Waldren said. EHRs need to get better at enabling such high-tech care and integrating patient data that results from those interactions.

• Make EHRs smarter. Consumer devices and software systems in other industries use data to predict what users want or should do and then offer easy ways to take those steps. “But the current health IT just doesn’t do that,” Waldren said. A typical EHR, for example, might alert a physician to a recommended test but won’t let the physician order it with a single click. It should, Waldren said.

• Become a virtual assistant. Waldren said he envisions EHRs doing more to support physicians as they practice. They could use voice and visual recognition via computer recording capabilities to automatically take notes and follow commands. Projection technologies could open and display information on a wall so the patient and physician could view it together. As futuristic as it might seem, it’s not far-fetched. Ehrenfeld said he’s involved with Department of Defense research studying how sensors worn by clinicians can sense and transmit exam data seamlessly and wirelessly back to EHRs.