Years after virtually all hospitals and nearly all medical clinics implemented their first electronic health records, EHRs have yet to reach their full potential to support streamlined physician workflow and clinical decision support. Craig Joseph, MD, medical director of the Madison, Wisconsin-based Medical Center. Nordic Consultinghas some perspectives on the situation, having practiced as a pediatrician for nearly a decade and then working for an EHR vendor. Las Vegas-based Joseph recently spoke with Healthcare innovation Editor-in-Chief Mark Hagland talks about the current moment in the development of EHRs and how they could be improved to better support medical practice. Below are excerpts from his recent interview.
How would you describe the current moment in terms of the ability of EHRs to truly support end-user clinicians in their daily work?
We are moving towards EHRs becoming more and more user-centric over time; I think technology has gotten better and better. I was an Epic employee from 2005 to 2011 and the improvements made since then have been amazing. I co-wrote a book on user-centered design in healthcare; but there is still room for improvement in the application of user-centered design in EHR. We are still not taking advantage of those concepts to the extent we could. So understanding how humans think and act, and what is important to them in the moment, and having technology wrap around that, is a big improvement. And I’m not even talking about rocket science or advanced AI. [artificial intelligence]; If we give people three options and 80 percent of the time they use option B, then we should choose option B by default.
And one of the best things about the EHR is that it contains a lot of information. At the same time, doctors feel like they are drowning in data. And large language models are really good at summarizing large amounts of data. So, summarizing the information for clinician ease of use: Those are the things the EHR has never been really good at; but the advances we’ve made in the last two years in terms of large language models mean that we will be able to better offer EHR use to physicians.
Will doctors be much more involved in development work in the future?
Well, the good news has been the emergence of the clinical informatics specialty; I was fortunate enough to become board certified. And for doctors to understand the technology well enough to communicate with their medical colleagues and with IT staff and developers, that’s important. My degree was in computer science; and it was uncommon to earn a degree in computer science and then go to medical school; That was unusual back then, now it’s not unusual. And Judy Faulkner [the founder and CEO of Epic Systems] He told me, there’s no way I’m going to hire you and make you write code; I have other people who can do that. What we need are strong clinical informaticists who understand the technology enough to talk to developers and who understand how doctors’ minds work, and who are able to jump back and forth.
However, one of the problems is that there are hospitals that ask: why do I pay a doctor to set up this order set, when I can just hire an analyst? Because of this, some people do not understand the value that clinical informaticists bring to improving care and reducing burnout. But yes, now we have this subspecialty. We understand how doctors and nurses think; And we know that when they say “I need this,” they really mean “I’m having trouble with these tools.” And computer scientists know it.
One thing that is clear at this point in the evolution of the health system is that the irreducible value is in the time of the doctor – the doctor and the nurse – because there is no substitute for their experience and care at this moment. correct?
I totally agree; Often, the technology is not the problem, but the environment (regulatory, legal, compliance) in which we practice. I’m still certified, but I haven’t practiced in years. But in my pediatric practice, I never started a note without what the nurse or physician assistant had started. And when we were all in the role, I had medical assistants diagnosing my patient, often before I walked into the room, and I knew it, because there would be a pamphlet about croup. And I would walk up and say, well, if Cheryl has diagnosed your child, well, she’s only right 98 percent of the time. So my plea is for things like team care, where we allow everyone to work at the top of their license and training. So we recognize that doctors are getting too many messages in their baskets; Sometimes that’s due to technology, but people have made configuration decisions.
For example, he often prescribed liquid amoxicillin for ear infections, but sometimes parents would leave the amoxicillin out overnight and then it would no longer be effective. And nurses and physician assistants knew they should automatically order another prescription for the rest of the course. And now, in many cases, the doctor is responsible for that decision, and that is not a good use of his or her time.
What will the next few years look like in this area as development progresses?
I think we will see a lot of progress around the summary; and hopefully I’ll be able to check the database – is there a trend with hemoglobin a1c results for example? Show me the last 20. Those types of interactions will happen in the near future. And we have multiple data streams. We have genomics; Meanwhile, people are moving to wearable devices. For example, I have an Apple watch. And the social determinants of health are another element.
In the future, all of those items will be available when the doctor needs them, to indicate that a patient’s care plan might be different because the patient lives in a food desert and we need a social work consultation or a referral to a health bank. food. We need to make it easier to do the right thing; so, prepare those orders and set them up the right way. Environmental listening is another element: documentation occupies a very important part of the time of doctors and nurses. And ambient listening is already happening; Two or three years from now, it will be unusual to see a doctor typing during a patient visit.
What would be your advice to CIOs and CMIOs, based on what they should be thinking right now?
I would say keep humans at the center, both the patients and the doctors and operations staff. Make it easy for them to do what you need them to do. Things become much more obvious when you focus more on helping doctors have high-quality time with patients; therefore, focus on the humans in the system: that will make many decisions easier.
