E-HEALTH - E-SANTE - PHARMAGEEK

The digitisation of medical records in the United States has brought benefits, but not everyone is content with how they have been implemented.

Advances in medical imaging and the proliferation of diagnostic and screening tests have generated mountains of data on patient health. Digital information technology has seemed poised to revolutionize health care in the United States since 2009 when the Obama administration made the technology part of plans to revive a sinking economy. The US government has now spent tens of billions of dollars on putting patient information at doctors’ fingertips.

Yet many physicians have come to hate their computers. Overwhelmed by administrative work, they now spend more time attending to data entry than they do interact with patients. So far, electronic health records have not been the panacea to efficiency and safety that many expected them to be. But problems are being identified, and as such systems mature, there is still hope that they will live up to their potential.

Forty years ago, when personal computers were in their infancy, a person’s medical records comprised a few sheets of paper in a folder. Two decades later, these folders were bulging with photocopies, printouts and faxes of test results, but the medical profession was slow to adopt a digital remedy.

Since the United States began its big push in 2009, the digitalization of US medical records has soared. Data from the US Department of Health and Human Services show that in 2017, 96% of hospitals and 86% of physicians’ offices in the United States had access to electronic health records.

Many patients recognize the impact that electronic health records have made. A 2019 poll by the Henry J. Kaiser Family Foundation, a non-profit health-care advocacy organization in San Francisco, California, found that 45% of US citizens think that electronic health records have improved the quality of care, with only 6% reporting a decline.

Yet, US primary-care physicians are discontent. In a 2018 survey by Stanford Medicine in California, 59% said they felt that the systems needed a complete overhaul. Health-care managers and developers of electronic health records are looking for fixes.

Electronic health records are not just a speculated source of physician burnout. They’re a direct cause for about 13 percent of providers, according to University of New Mexico researchers who recently examined the effects of EHR implementation and use. 

The issue runs even deeper, says Dr. Philip Kroth, a professor at UNM’s School of Medicine. Researchers also discovered about 40 percent of all clinical stress is closely tied to clinical culture and its processes — things heavily influenced by EHRs.

“We are losing the equivalent of seven graduating classes of physicians yearly to burnout and, as they leave the profession, they point their finger at the time now required for them to document their work and how it has led to the loss of quality time spent with patients and families,” said Kroth in a September news release about the research.

But it doesn’t mean that organizations should give up hope on EHRs.

Many healthcare systems have begun looking more closely at technological advancements — including data standards, artificial intelligence and predictive analytics — to not only generate more efficient EHR processes but also to bring the systems back to their intended function: enhancing patient care.

With that goal in mind, here’s a look at three ways EHRs are expected to improve in 2020 for patients and providers alike.

READ MORE: Discover how healthcare IT leaders can help clinicians prevent burnout.

1. Natural Language Processing Will Enhance Workflow and Experience

Speech-recognition software is already fundamental to changing the way medical professionals work, and natural language processing takes that to the next level, enhancing interactions with EHRs. 

This type of software can automatically capture audio via a microphone and decipher what’s being said, what information is important and where it needs to live within a patient’s EHR. These software programs save clinicians valuable time by reducing paperwork and allow them to be more present with patients.

Last year, the not-for-profit Minneapolis healthcare system Allina Health introduced Nuance Communications’ Dragon Medical One, a medical speech-recognition solution, across its entire organization.

“We want our providers to be able to detail their thoughts and words in the EHR in the most expedient way,” Mary Lambert, information services director for Allina Health, says in a Nuance case study. “If we can demonstrate the efficiency of speech recognition, we all win.”

Victories have been many: In less than a year, Alina has witnessed an improvement in clinician workflows and EHR experience, with the organization’s adoption rate for the software reaching 80 percent. As its staff continues to shift away from legacy solutions, the healthcare system has also seen a 167 percent growth rate in the amount of documentation providers are generating.

MORE FROM HEALTHTECH: Learn how the Dragon Medical Practice Edition improves workflow.

2. Predictive Analytics Will Empower More Informed Care Decisions

Predictive analytics applications are already influencing various areas of healthcare, from optimizing emergency staffing to impacting cancer treatments, and its adoption is not expected to slow anytime soon.

The analytic method uses modeling, statistics and data mining along with AI to predict clinical outcomes based on EHR and real-time device data to improve care delivery and patient experience. These applications are positioned to become even more useful when coupled with natural language processing. 

In 2018, NorthShore University HealthSystem developed the Clinical Analytics Predictive Engine to act as a tool within their EHR system to provide clinicians with more actionable information on patients. The project, known as CAPE, takes into account critical information such as lab results, patients’ vital signs and their admission histories. Such measurements are helping the Evanston, Ill.-based system to generate risk scores for patients that identify their likelihood of suffering from cardiac arrest, readmission or even death.

Preliminary data shows that after a three-month pilot of the CAPE predictive analytics model, NorthShore was not only able to reduce its number of patients who experienced cardiac arrest, but its overall mortality rates as well.

“It's working; it's providing value to physicians,” Dr. Nirav Shah, an infectious-disease physician at NorthShore, tells Modern Healthcare.

3. Patients’ Access to Their Medical Data Will Continue to Expand

Providing a positive patient experience is critical for healthcare organizations, especially as mergers and acquisitions disrupt the industry. So, it might not be surprising that 69 percent of healthcare executives surveyed by Sage Growth Partners said that improving the patient experience was a top priority in 2019 — a goal that is likely to endure. 

What’s more surprising is the number of respondents that cited EHRs and patient portals as the top conduits for doing so, at 90 and 83 percent, respectively. 

Some organizations might see these tools as separate entities, but Northwell Health believes that both must work in harmony.

John Bosco, the health system’s CIO, recently told HealthTech that patient portals ought to act as a primary method for collecting, storing and sharing health information between patients and clinicians. Patients, he says, enjoy “the convenience of being able to see their records, renew a prescription and send a secure message to a physician.”

But many portals have limitations. “They only perform your most basic functionalities,” says Bosco, referencing portals that were built simply to check the box of having one. The next generation of portals, he notes, are improving in step with advancements in healthcare tech.

When it comes to the New York system’s plans for its own portal, Bosco says the ongoing goals are greater accessibility to and usability of EHRs via patients’ mobile devices. Northwell also has aspirations to provide patients with tailored medical treatment options based on their EHR data, making the portal a crucial element of the care relationship.

Artificial intelligence has been the stuff of stories for years – it’s a buzzword that has infiltrated conversations about technology in all industries.

Thought leaders have lauded the possible uses of AI in chat bots, virtual assistants, when interpreting lab results, by improving clinical documentation, when treating PTSD in veterans, etc. Artificial intelligence is gaining traction across the board and particularly in healthcare.

Whether it’s IBM Watson Health, Apple’s foray into EHR, or an Amazon Alexa for healthcare… the race to include artificial intelligence in healthcare and eHealth tech has started.

These tools are potentially big steps forward for healthcare technology, but there have been more incremental changes as well.

With the integration of artificial intelligence, our standards are rising for the tech we use to manage healthcare. Most EHRs or EMRs now include a number of add-on features that can enhance clinical decisions.

However, data is simply no longer enough.Leonard D’Avolio, CEO and co-founder of Cyft put it well when he said, “we do ourselves a disservice when we refer to [artificial intelligence] as something that we just take a ton of data, push a button and cure cancer.” He thinks that healthcare professionals need “to be more realistic about what these tools can and can’t do.”

Understanding data and what a customer truly needs is the “foundation for transformation,” D’Avolio continues.

Here’s what it comes down to (and what D’Avolio is saying): the discussion around artificial intelligence requires nuance. A doctor or medical professional brings practical experience to the table. Artificial intelligence will never be able to replace the instincts honed by years of experience.

EHR and healthcare tech companies must develop ways to incorporate the individual experience and wisdom of doctors into the technology itself. Every provider is different and deserves a tool to capture his or her unique practice.