The promise of electronic health records
Insights from a national symposium
The health care industry hadn’t been known to move quickly — then electronic health records came along. In 2009, when the federal government spent billions of dollars to encourage a switch from paper records, only 1 in 10 physicians used electronic records; now 9 in 10 do.
“We have made a colossal transformation in a relatively short period of time,” said Lloyd Minor, MD, dean of the Stanford School of Medicine. “But we have not realized the potential benefits of electronic health records.”
That was the consensus at Stanford Medicine’s Electronic Health Records National Symposium in June, where attendees discussed the problems and potential of electronic records, and made recommendations for bringing home a vision of digital health care enabled by the technology.
That vision is for the electronic record to recede into the background, even as it enhances the ability of physicians to focus on their patients. Information would flow seamlessly to all parties who handle a patient’s progress through the health care system.
Physicians would have, at their fingertips, a synthesis of the patient’s history, relevant medical literature and the histories of similar patients in anonymized, aggregated form. In other words, electronic health records would enrich care decisions with knowledge and context.
Today, the technology is viewed, at best, as an optimized storage medium and, at worst, as a major distraction from patients. Few physicians regard the electronic record as a tool to support clinical decision-making. To get there, symposium participants offered ideas about best practices and ways to improve the electronic health record experience. The ideas were captured and discussed in detail in a white paper released in September and available online at http://med.stanford.edu/ehr/whitepaper.html.
Here is a sampling of the key takeaways:
Many physicians feel burdened by EHRs. But organizations that emphasize teamwork and training — and devote higher-than-average amounts of time to training physicians — report higher levels of physician satisfaction.
Common standards — from patient data to payment
Common standards for patient data are needed to enable seamless data sharing within and across organizations. Moreover, payers need to agree on a common set of data and formats for reimbursement and quality reporting. This would greatly reduce the bureaucratic burden on practices.
Open-source software tools
EHR developers must move away from building “walled garden” ecosystems toward something akin to today’s smartphone app store. Open-source software programming can help accelerate this in the future, promote data sharing, and nurture a community of third-party developers who are better positioned to customize electronic records to serve the many stakeholders who rely on them, including patients.
Machine learning has the potential to help physicians quickly get up to speed on a patient’s clinical history and make notes during the patient visit, and could suggest actions for clinicians to take, based on established clinical guidelines. Through various initiatives, researchers are bending artificial intelligence toward these aims.
Junk the fax machine
A third of the nation’s physicians still rely on this antiquated device to communicate with each other, patients, payers, staff and others, gumming up an already overly bureaucratic system. Federal and private payers can help by providing incentives for using their websites instead of a fax machine. It would help, too, if all physicians embraced electronic payment systems.