EHRs as Patient Data Repositories
Much has been said about the value of EHRs in collecting patient data, and using that data for various purposes. And, to date, EHR installations have done that – accumulated data within the confines of their installation. Large installations with Enterprise Charts that cover millions of patients (e.g. Kaiser) have used this data to gain insights into disease trends, clinical quality and best practices.
Some companies, in fact, base much of their business value on the unique nature and scale of their internal patient data (e.g. Practice Fusion). Again, to date this has been true.
However, the need for interoperability is critical. Patient data needs to be shared across enterprises. Meaningful Use Stage 2 sets some requirements for vendors to be able to export and import summary patient data (via creation / consumption / transport of C-CDA standard documents).
At the same time, we are seeing the emergence of the next level of aggregation of patient data. New “next generation” platforms, though still quite nascent, are being built and deployed that allow patients to request data from all their providers, regardless of what EHR they use, and collect them in a central place that is outside the data silos of any installation or vendor. It is these new, global patient data repositories that will, over time, become the aggregated center of patient data. EHR vendors and installations will see their data leach out, as patients request copies of their records from their doctors, and put them into new, aggregated places outside the EHR.
Related: Patient Centered Data Is The Best Solution for “Meaningful Consent”
EHR’s Role in this Next Era
So if not the place for global patient data, what, then, is the role that EHRs will play down the road? The data displayed by an EHR may come from local or external sources. What will EHRs be used for, then?
EHRs are practice tools, and need to enable efficient workflows in a clinical setting – a doctor’s office or a hospital. Many of the current complaints about EHRs are about how clunky they are and how they slow down workflows, reducing efficiency, and turning physicians into educated data-entry staff. These frustrations have led to much of the discussion about EHR usability, and the need to make these tools more modern and efficient.
Here are some elements that modern EHRs should achieve. I would suggest these be considered overarching goals – if a vendor can accomplish this, they will be successful. If not, then a rip-and-replace decision will need to be addressed.
Physician documentation of a patient encounter must be very quick. Much of the volume of documentation currently done (and EHRs are good at turning small notes into big ones) is done for billing support (a by-product of a fee-for-service system) and forensics. Natural Language Processing is a technology that is emerging, and may play an important role in helping a physician document the encounter. The goal of “two clicks and you’re done” should be targeted. Swift documentation capability, customizable macros, voice or click creation of notes – these are what we need to achieve. An EHR should not make it necessary for physicians to hire scribes to follow them around and do data entry.
Streamlined workflows need to be handled by the EHR. In ambulatory settings, this means good handling of external documents, messages, and communication with patients. Some of the new aggregated technologies may have unified patient portals, so that a patient only needs to log in to one place to access all one’s physicians and communicate with them – a modern EHR should be able to facilitate this.
Open access to internal data is another thing EHRs will need to do. There is no way that a vendor will be able to anticipate all the reporting that a given practice will want to do – clinical quality measures, disease trends, demand that will affect staffing levels are all examples of reports or dashboards that a practice may want to achieve. Rather than expecting a vendor to do this themselves (it will take a long time, and will likely be expensive), an open API access to one’s data can allow a whole ecosystem of “satellite” companies that can create the reporting, analysis and visualizations that a practice (or hospital) might need.
Related: Taking A Patient-Centered Approach to Building Healthcare Data
Conclusions
The role of EHRs will change. Now that we are past the “implementation phase” of EHR use, and are moving more to the “optimization phase”, it is clear what we need our tools to be. EHRs need to facilitate practice (or hospital) workflows. They need to move away from documentation time-sinks and embrace technologies that will allow documentation to be finished by the time the clinician leaves the exam room.
In the era of connecting patient’s data across different care settings, the role of EHRs as primary data repositories will diminish. EHRs will collect local data, but will need to share (in a two-way fashion) internal data with external sources. Good medical practice will be the result of this.
The next level of health IT can be seen from here. My entrepreneurial side says, “now, let’s build it!”
Dr. Rowley writes regularly about his clinical & technical insights into health IT on his site: Robert Rowley MD where this was first posted.
