Patient-Centered Care

EHRs: A Look at Their Problems and Potential

Healthcare organizations, which have a love-hate relationship with the record systems, are continuing to look for ways to make them work in their favor.

Jen A. Miller

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Jen A. Miller is author of Running: A Love Story. Her work has appeared in The New York Times, Washington Post, CIO Dive, Supply Chain Dive. and Runner's World. She lives in N.J. with her dog Annie Oakley.

The complaints about electronic health records are well known — they take time away from patients, their records don’t translate from one doctor to another, they create a glut of inaccessible information — all of which have led to a spike in physician burnout.

The topic made for hot discussion on Saturday at the American Heart Association Scientific Sessions in Philadelphia, when panel experts touched on some of the trouble associated with poor EHR implementations.

EHRs “have been overpromised,” said Dr. Tariq Ahmad, an assistant professor in cardiovascular medicine at Yale University School of Medicine and the Yale New Haven Health System. “The entire point of these things was to be able to share data, but healthcare systems view data as something they need to hold on to, even to the point that most patients cannot get access to their data.”

Although the problems associated with EHR systems kick-started the conversation, the panelists agreed that the current capabilities and potential of the technology in the systems still make it a worthwhile investment for organizations when implemented properly. The panelists see two fixes — how the data is shared, and who touches the data — as a way forward, helping to pivot the primary focus of physicians back to their patients.

The Operational and Clinical Benefits of EHRs

At McMaster University in Ontario, physicians in the critical-care department use the Hamilton Early Warning Score (HEWS) to reduce the rate of in-hospital cardiac arrests. The score, created within an EHR, is based on a patient’s vital signs as input by the clinician. If the system finds vital sign abnormalities, it will trigger audiovisual notifications for care providers to take further action, whether by calling on a response team or monitoring the patient’s vitals more closely.

Not only does the system calculate scores in real time, said Dr. Alison Fox-Robichaud, professor of medicine at McMaster and staff physician at Hamilton Health Sciences, but also, with few exceptions, it doesn’t allow clinicians to skip inputting vital signs. In fact, the system ensures that vital signs are input quickly — a key benefit because delays in recording this information could result in up to double the risk of ICU admission.

After implementing the HEWS system, McMaster University saw a 61 percent reduction in their cardiac arrest rate.

While the organization encountered some initial resistance, Fox-Robichaud said that a better understanding of the specific healthcare environment made a difference in the HEWS adoption rate. “We had a medical anthropologist student working in the unit, just to look at how nurses interact with vital signs and their culture around vital signs and how they interpret them,” she said.

How Tomorrow’s EHR Can Improve the Quality of Care

Developments in voice and gesture technology have the potential to improve EHRs’ usability, said Raj Ratwani, director of the MedStar Health National Center for Human Factors in Healthcare. Advancements in these technologies will further enable the passive collection of patient information during medical appointments, with the collected data being input directly into the patient’s EHR.

“The future that we hope for is the exact opposite of today’s practice,” he said, “with technology taking a very small part of the space in the room and not being as front and center as it is now. Instead, information is captured in the background.”

Moving data collection and input out of clinical hands through the adoption of next-gen technologies will ultimately help pave the way for improved quality of care.

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