Academic and scientific presentations can get tedious, so it was a breath of fresh air to attend an “Ignite” session at this week’s American Medical Informatics Association (AMIA) Annual Symposium in Chicago.
That format supports a rapid-fire parade of research reports, 11 in the space of 90 minutes in the case of one session on electronic health records (EHRs). It also helped a certain sleep-deprived MedCity News correspondent stay awake in the first time slot after lunch.
Specifically, speakers had a lot to say — in about 8 minutes each, including Q&A — about how EHRs were less than optimal and how to improve the technology.
“We’ve all been lied to,” said Dr. Christopher Hollweg, a clinical informatics fellow at the Phoenix campus of the University of Arizona. EHRs were supposed to make life easier for physicians. They largely have not.
“Notes are too big, there’s too much data and it takes too long,” added Dr. James J. Cimino, director of the Informatics Institute at the University of Alabama at Birmingham.
“We put in the findings, but we don’t say how they relate to each other,” Cimino added. “We also don’t capture the patient perspective in any coded way.”
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Dr. Jeffrey M. Weinfeld, a family physician affiliated with Georgetown University, said that clinical notes take a lot of time and often are not all that effective in capturing the patient story. He recommended that anyone who didn’t believe him should Google ZDoggMD’s “EHR State of Mind” (or just click our handy link).
Physicians are losing out on what Weinfeld called “pajama time”; rather than relaxing at home, they’re charting patient encounters, and often not doing that very well.
“This is a real problem,” Weinfeld said. “This is an issue in physician burnout.”
But they didn’t just complain. They offered ideas.
Weinfeld referenced a 2003 journal article that called patient safety a “shared responsibility” between physicians, nurses, institutions, educators, professional organizations, accreditation bodies, governments and, yes, patients, too. He said the same attitude is necessary to improve EHR-related patient safety.
(Dean Sittig, a bioinformatics professor at the University of Texas Health Science Center at Houston and an AMIA board member, noted that shared responsibility has been slow to catch on. He cited the example of Texas Health Presbyterian Hospital Dallas, which initially blamed its EHR for missing an Ebola diagnosis in 2014, then backed away from the accusation.)
There also needs to be regulatory reform as well as an accelerated shift toward payments for quality and a sharper focus on best practices in primary care workflow, according to Weinfeld. “We need a lot more research in primary care informatics,” he said.
Cimino called for a different approach to patient notes within the framework of current IT systems. “We can’t blow these things up,” he said of EHRs.
“We need to capture the ‘why'” of each patient encounter and then integrate that information with the existing patient record, the UAB physician executive said. “We must get the system to write the note. Not a note, the note,” he emphasized.
Hollweg got specific and high-minded. “I have a dream. I have an EHR dream,” he said.
That dream consists of three points for building better EHRs. Systems should: have “situational awareness,” accounting for context in capturing and delivering information to each user; incorporate voice recognition, allowing the EHR to be a “silent observer” in the room; and include a “bi-facing PHR and EHR,” Hollweg said.
On the last point, he explained that institutional EHRs and personal health records ought to present the same information in different contexts to suit the intended audience. Patients want plain English, not medicalese, Hollweg explained.
Photo: Flickr user Thomas Hawk
