MedCity Influencers, Physicians

Covid-19: A tipping point for EHR innovation

EHRs have caused a few problems for healthcare but they have paved a path on which we can set out on the journey of healthcare transformation.  Without the existing EHR infrastructure, we’d not only have to map out a path but lay the road while we’re on it. 

Healthcare providers have often been labeled as luddites when it comes to integrating technology into the delivery and management of patient care. But Covid-19 revealed the inaccuracy of that stereotype. Consider telemedicine, and the overwhelming and fast adoption of delivering care virtually. Seattle-based Providence St. Joseph Health saw virtual urgent care visits jump from 50 per day to 1,500 per day; and the Department of Veterans Affairs retooled its telehealth system to handle more than 15,000 patients in the system at any one time when its prior capacity could only accommodate 3,000 at once.

What the pandemic has proven: Providers are not opposed to technology; they are against technology that doesn’t make patient care – or business – sense. When telemedicine wasn’t being reimbursed, doctors weren’t using it in large numbers. But now we have the power of focus; we quickly needed to find ways to take care of patients, and rules, restrictions, and barriers were removed to make that possible. Providers responded swiftly, adopting the technology necessary to connect with – and deliver care to – their patients.

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A Deep-dive Into Specialty Pharma

A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.

Over the past one year, we’ve seen many organizations accelerate through their digital roadmap by five years. As we look ahead, we can expect these tech-excited (or, at least tech-converted) providers to have higher expectations for the tools they use to deliver and manage patient care. One tool in particular — the EHR — at the center of it all.

EHRs laid the groundwork for virtual care
I know how easy it is to focus on the negatives of EHRs (trust me, I could write a whole other article on that), but without them, we wouldn’t have been set up for the moment in which we find ourselves. The reality is, with EHRs, providers can log in from almost anywhere in the world to get a patient’s information. While we might not be traveling much these days, many providers are working from home and seeing patients in theirs, making it necessary that we can securely access a person’s health history with a few clicks of the mouse, and on any connected device.

Now that we’re here – where we can see the value in having a foundation and delineate priorities and needs – we can all agree the system is ripe for disruption. Healthcare has been arguing EHRs were broken when they were barely just built. I don’t disagree, but do believe that since we’ve been thrust into this new world, we can more clearly identify and articulate the path that disruption needs to take. Plus, now that the world of innovation is even more focused on healthcare – including the investment community – we are entering a perfect storm for real change.

The technology is pushing – or, for some, pulling – us towards a post-EHR era. Here’s what I think (and hope) that looks like.

ATM-like standardization
In this new world, EHR systems are commoditized, with standards that make it so anyone using one, regardless of the vendor, can jump in and navigate easily – without months (or years) of training and the practice-makes-perfect approach needed when switching from one to another today. A good external example is the ATM. When the banking industry decided to adopt and implement standards, ATM machines – no matter what bank you visit – became easy to use. You know where to put your card, where/how to punch in your pin, and where to collect the money.

In this new world, the formula would be computer + person is greater than person alone. Unfortunately, we’re not quite there yet; we don’t have “smart” systems that remove unnecessary duplicates or interpret data and present the most relevant. We need to get to a standard system where — no matter the EHR — when a cardiologist logs in, they are able to see cardiology-specific information about the patient up front.

To get there, we will need some policies against data blocking, a focus on and regulation of certain standards, and focused, collaborative disruption from the tech world that aims specifically to standardize and streamline the EHR experience. 

Data gathered automatically

I don’t think there’s a practicing provider out there who wouldn’t love to see data used more efficiently and effectively, in order to improve care and outcomes. For example, if I receive a list of a patient’s blood pressure readings for the past several weeks – with no way to see the times it spiked and what they were doing when it did without going through the entire reading – that data is unusable. There simply isn’t enough time in a provider’s day to sort through that kind of data for every patient, or even a select few.

The post-EHR world of the future will have smart (likely AI and machine learning-driven) processes and systems to filter data and present it in a way that fits into a provider’s workflow. For example, I want to know as soon as I pull up the patient I’m about to see that she was recently seen at a hospital, what the visit was for, and any diagnosis or next steps.

I anticipate we’ll see a big shift in this area over the next five years. Covid-19 jump-started the process; it easily cut five years off the timeline to achieving this kind of system-wide progress. Like with standardization, we will need some government participation and oversight – ensuring telemedicine continues to be reimbursed, for example. We will also begin to see progress as we move to new documentation guidelines that will make that process a whole lot easier.

End of data-blocking

This, of course, ties into data gathering and standards. If I can’t get data about a patient because another EHR or health system won’t share it, I am unable to deliver the best care. If she sees five doctors, and I can only access her health information from four of them, I’m missing a big chunk of her health picture – from diagnoses to medications.

Not only do we in healthcare need to keep up with the digital experience of other industries, but we also need to face the facts about our patients and their lifestyles. People are simply not as stationary as they used to be. Thirty-five percent of baby boomers switched doctors between 2015 and 2017 and more than 40 million Americans move each year, making it clear that healthcare needs a way to easily transfer, share and analyze patient data. It’s simply unacceptable to put the onus on the patient to go back to each provider and collect their records before changing doctors or cities, in order to assemble their complete medical history.

This, of course, will require government involvement through enforcement. Fortunately, we are seeing progress on this front with the 21st Century Cures Act, but that will take a bit longer to make its way into the system, with compliance dates and time frame delays due to Covid-19.

While this seems like we have a long way to go, it’s less about the distance and more about mapping out the best path. It’s clear that EHRs haven’t solved all of healthcare’s problems (I think it’s safe to say they’ve even caused a few,) but they have paved a path on which we can set out on the journey.  Without the existing EHR infrastructure, we’d not only have to map out a path, but lay the road while we’re on it.

Photo: sturti, Getty Images

Douglas McKee, MD, is a board-certified family medicine and informatics physician, serving as Chief Medical Information Officer at Health First, a $2 billion integrated delivery network and an Inlightened expert. A collaborative leader known for bridging the gap between clinical and IT stakeholders, Dr. McKee leads IDN change management, electronic medical record modernization efforts, and digital strategy, in addition to directly caring for patients. Dr. McKee previously spent the nearly a decade as the National Clinical Lead for Emerging Health Technologies at the VA, the world’s largest and most complex medical system. His focus on improving the overall healthcare experience of patients and providers alike is driven by a unique combination of expertise in patient care, access, local and national informatics, human factors engineering, and modern IT. Having worked with paper records, athenahealth, CPRS, Centricity, Epic, eClinicalWorks, and Meditech, Dr. McKee is uniquely equipped to support organizations in their efforts to mobilize innovative approaches and technologies that combat physician burnout. Dr. McKee is a member of several local and national organizations and committees, including the American Medical Informatics Association.