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Monday, April 9, 2018

"Fix the EHR!"

From THCB:

After a blizzard of hype surrounding the electronic health record (EHR), health professionals are now in full backlash mode against this complex new tool. They are rightly seen as a major cause of professional burnout among physicians and nurses: Clinicians are spending almost half their professional time typing, clicking, and checking boxes on electronic records. They can and must be made into useful, easy-to-use tools that liberate, rather than oppress, clinicians.

Performing several tasks, badly. The EHR is a lot more than merely an electronic version of the patient’s chart. It has also become the control panel for managing the clinical encounter through clinician order entry. Moreover, through billing and regulatory compliance, it has also become a focal point of quality-improvement efforts. While some of these efforts actually have improved quality and patient safety, many others served merely to “buff up the note” to make the clinician look good on “process” measures, and simply maximize billing…
Above, my Photoshop reaction.

I've cited Dr. Wachter multiple times on this blog.

My solution? My next iteration of my Clinic Monkey EHR will be "Blockchain Monkey EHR!"

But, according to "Healthcare Kate," "EHR's are a dying technology."

"Relational Leadership™" to the rescue?

Stay tuned. Just getting underway. A lot going on at my house these days. None of it fun.


I'm demonstrably no newcomer to crackin' on EHR technology policy.

See "ICD-10: W6142XA, Struck by turkey, initial encounter."


After reading this week's accruing comments under the THCB "Fix the EHR" post, I feel like it's pointless to yet again point out the direct experience-based assertions I've posted many times. It's not the technology per se, it's the prevailing "productivity treadmill" economic paradigm (including the "shards" of a fragmented system) which leaves clinicians insufficient time to document their work in a timely, necessary, and accurate fashion. Nibbling around the edges, tossing out frustrating, admittedly dubious value "process indicators" (they are not "clinical quality measures") won't move the needle visibly (not that we shouldn't pare them back).

I'd ask these aggrieved blog commenter policy geniuses: "which of the (hundreds to thousands) pt encounter SOAP note elements would you discard?"

Paper is not "better." Paper kills. As does the prevailing socioeconomic / political system as it impacts health care.

Yes, my own broad, multi-EHR in-the-trenches HIT experience is getting a bit dated. But, my world is now "All Epic, All The Time" as my daughter's caregiver and as a patient myself. I continue to be a keen observer of the workflows I see during our clinical interactions.

Yes, clinicians suffer from 'burnout," worn down by impossible demands. But cutting the guts out of EHRs or tweaking the UX at the margins, well, not gonna get us anywhere.


eClinicalWorks CEO Girish Navani: Our next EHR will be like a Bloomberg Terminal
The electronic health record vendor is working on a version that would run on monitors such as Microsoft Surface and feature four distinct panels to help doctors make decisions.

LAS VEGAS – While eClinicalWorks is demonstrating its latest cloud-based EHR and new offerings for inpatient settings at HIMSS18, CEO Girish Navani gave a glimpse of the forthcoming iteration — and the goal is to resemble a Bloomberg Terminal.

The hosted service would make a bold step forward for the EHR vendor that last year settled a $155 million case with the U.S. Department of Justice in a False Claims Act suit.

Much in the way the Bloomberg device delivers information to help bond traders make decisions in near real-time, the next version of eClinicalWorks will provide doctors with four key technologies each on its own screen.
Navani described the setup as such: A physician walks into her office with a big monitor that has a population health panel containing information about the patients the doctor will see that day, a telemedicine tool for virtually connecting with patients, a voice-based virtual assistant for interacting with the software and a machine learning-based panel making evidence-based clinical suggestions…
 OK, then. More data onscreen, fewer mouse clicks? What about quickly actionable data "visibility?"

More to come...

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