The Covid-19 crisis has illuminated longstanding deficiencies across our healthcare system. Never before has such a light been cast on the plight of frontline healthcare workers as they put themselves in harm’s way to keep the rest of us safe. They deserve our enduring gratitude for their sacrifice.
More importantly, they deserve a better system. Before the pandemic, physician burnout was already surging. A study from the American Medical Association (AMA) clearly defined “6 big things that must change to beat physician burnout” and one of the big things is to “enable technology solutions.”
Electronic Health Record (EHR) systems, one of the most ubiquitous systems used in healthcare, have encumbered doctors, adding to the stress of practicing medicine and taking away from patient care. In fact, 40% of physician burnout is attributable to EHRs, according to a group of researchers from the University of New Mexico (UNM). Built to fulfill regulatory requirements and harnessed to impose billing priorities over patient care, EHR systems lack the utility to effectively support the dynamic needs of clinicians.
Limitations of Medical Record Systems
As Dr. Atul Gawande highlighted in his seminal “Why Doctors Hate their Computers,” making great software that meets users’ needs, especially those as complex as clinicians’, requires an iterative, evolutionary process that employs an incredibly tight feedback loop with end-users. There’s no greater UX pro than an actual user. Unfortunately, Dr. Gawande argues, our current EHR system design is the result of “selection,” rather than “mutation,” and that type of top-down design inevitably results in a sub-par user experience. This is especially concerning when centralized design decisions don’t make clinical users their top priority, as billing takes precedence over patient care.
The very nature of EHR systems as the “system of record,” puts limitations on their ability to support complex clinical care. Record-keeping tools prioritize stability, not agility. Further, EHR systems place a clear emphasis on documentation, on tracking care to bill and to enable administrators to manage that care. This focus leaves those actually providing patient care out of the picture.
The challenges resulting from the static nature of EHR systems have been especially problematic during the rapidly changing era of Covid-19. Health systems have needed to quickly change how they operate and set up field hospitals and surge facilities. These unprecedented changes to how care is delivered require agile technologies to support them.
Evolution to Platform Models
Until recently, medical records maintained a chokehold on data liquidity. A key problem with EHR systems is interoperability that allows the effortless flow of data. As reported by NPR, proponents of electronic health records expected a seamless system so patients could share computerized medical histories in a flash with doctors and hospitals anywhere in the United States. That has yet to materialize, largely because officials allowed hundreds of competing firms to sell medical-records software unable to exchange information among one another.
A potent combination of legislative, competitive, and technological shifts is breaking down these walls allowing access to patient data across systems. In the past few years, all of the major EHR vendors have embraced “app store” models to enable an innovative ecosystem that can solve problems that the EHR vendors themselves could not or would not.
The EHR’s transition to platform models has largely been enabled by the advent of application programming interface based integration in healthcare. APIs bring the first truly standardized integration capabilities to healthcare, radically reducing implementation timelines for new clients from many months to a matter of days. This exponential drop in the time and effort required to adopt new technologies eliminates one of the most legitimate barriers to the proliferation of advanced technologies in healthcare.
The EHR systems have proven a fundamental stepping stone, but insufficient to meaningfully advance patient care. Success for EHR vendors depends on how well and quickly they embrace this platform strategy, and the success of health systems depends on how well and quickly they incorporate these innovative technologies into their operations.
Now that meaningful API-based integration is finally a reality in healthcare, systems of clinical intelligence are emerging to meet physicians’ needs where EHRs have fallen short. These systems span the breadth of physician workflow and have the potential to drastically improve both provider wellbeing and clinical care. The great disruption of Covid-19 will provide an opportunity for healthcare providers to accelerate the implementation of AI-based systems, designed with intuitive interfaces, able to extract all the patient information across the patient’s medical record, predict the clinical content that is most relevant for the physician to see, and surface that content in contextualized, physician-friendly format. Our doctors and patients need these new and innovative systems and we owe it to them now than ever.
More agile, flexible systems, incorporating the latest advancements in technology to support physician workflow are essential to addressing the present Covid-19 crisis and moving the industry forward as a whole. Our healthcare workers deserve this.