Symposium focuses on improving electronic health records

The daylong event touched on fixing inefficiencies in EHRs, harnessing data for population health management, building on successes and overcoming obstacles.

Lloyd Minor gave closing remarks at the Electronic Health Records National Symposium, which was held June 4 at the Li Ka Shing Center for Learning and Knowledge.
Rod Searcey

A Stanford Medicine survey conducted by The Harris Poll found that more than 6 in 10 primary care doctors say electronic health records have led to improved patient care. However, a majority also report frustration with how the demands of the digital systems affect their relationships with patients.

Presenting the results June 4 at Stanford Medicine’s EHR National Symposium, Lloyd Minor, MD, dean of the School of Medicine, said the survey illustrates the gap between the potential and current reality of the documentation technology. He charged the attendees — leaders in patient care, technology, design thinking and public policy — to chart a future that fulfills the clinical promise of EHRs while reducing the administrative burdens.

 “We absolutely don’t want today to be about pointing fingers or trying to assign blame,” Minor said. “The goal of today’s conference is to define where we are today, identify the opportunities for the future, and begin to form a road map about how we succeed in achieving those opportunities.”

With panel discussions and breakout sessions focused on problem-solving, the daylong symposium touched on fixing inefficiencies in EHRs, harnessing data for population health management, building on successes and overcoming obstacles.

The online survey — of more than 500 primary care physicians throughout the United States — provided a baseline of opinions and experiences.

What doctors report

Two-thirds of doctors report being at least somewhat satisfied with their electronic health records system, though 4 in 10 say the records bring more challenges than benefits, according to the survey. About 7 in 10 physicians say EHRs take valuable time away from patients, and an equal percentage say the systems contribute greatly to burnout.

Of 31 minutes devoted to a patient, doctors estimate they spend 12 interacting with the patient, eight interacting with the records systems during the visit, and another 11 minutes on the computer after the visit, according to the poll.

Though data entry required by digital systems can be burdensome, local culture and workflow can influence how physicians regard their EHR experience, panelists at the symposium said.

Christine Sinsky, MD, vice president of professional satisfaction at the American Medical Association, said that over 16 years, she’s seen expectations for digital documentation grow. “The expectations that every act must go through the EHR, that we translate the clinical experience into digital data for the convenience of others and not for advancing clinical care — those pressures have increased.”

Taylor Davis of KLAS, a company that compiles and analyzes user feedback on health information technology for vendors, said surveys with more than 20,000 respondents found that organizations with the most satisfied workers were not the ones with cutting-edge technology, but those that emphasized teamwork, training and understanding how to use the system.

New York Times reporter Reed Abelson (far right) moderated a panel that included Donald Rucker (middle), the national coordinator for health information technology at the U.S. Department of Health and Human Services, and Judy Murphy (left), chief nursing officer with IBM Global Healthcare.
Rod Searcey

“These are organizations where physicians realize that it’s a myth that the [EHR] is going to be intuitive enough that I can just pick it up and use it out of the box,” said Davis, a vice president of analysis and strategy at the company.

EHRs for better care

Some organizations at the symposium reported using data gleaned from EHRs to inform and improve care. Stanford Children’s Health devised a tool that collects information on cases of jaundice in premature infants to be analyzed alongside expert-based consensus to ensure best practices continue to be followed as they evolve. Intermountain Healthcare created a transportation program for Medicaid patients after an analysis of patient records revealed that a main reason they were visiting the emergency department for nonurgent care was lack of transport.

At Kaiser Permanente, Brian Hoberman, MD, said there have long been numerous opportunities for health care based on patient data, and identifying patients that need a particular service is not difficult. One challenge is prioritizing which health needs to tackle with the data. Another is addressing the occasional barrier from individual patients’ lives.

“We’re able to find folks who need to come in to manage their diabetes or hypertension, and we’re able to actually pick them up,” Hoberman said. “That doesn’t necessarily mean that they’re going to choose to come in, for whatever reason.”

Engaging patients more actively in their care has been a major benefit of electronic health records, panelists said. Through portals created for them, patients have started participating more in decision-making and care planning, said Judy Murphy, chief nursing officer with IBM Global Healthcare. Patients are now thinking more about health care as a way of life rather than as episodic encounters, she said: “That has been a huge boon to the way we think about care in the United States.”

Though some said providers and other health organizations are unlikely to invest in changes without a financial or regulatory incentive, others said patients, as consumers accustomed to the online retail experience, would drive innovations in electronic health records — particularly as they assume more of the health care risk because of developments like high-deductible insurance plans.

A big step forward is the new Apple Health Records application programming interface, said Donald Rucker, MD, the national coordinator for health information technology at the U.S. Department of Health and Human Services. The API will allow developers to create apps that can use electronic health records data to help people manage their health care, medications and more.

“Some of the more esoteric things — the machine learning, all of that — will piggyback off that broader consumer involvement, the way it does in other industries,” Rucker said.



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