Physicians: Make health IT user-friendly to improve care delivery

Electronic heath records (EHRs) and other forms of health information technology have the potential to significantly improve care delivery and patient outcomes. But that can’t happen until the technology becomes more user-friendly and patient-focused than it is today.

That was the message delivered to physicians attending a session on the future of health IT during the 2017 American College of Physicians (ACP) conference in San Diego. Session speakers included Peter Basch, MD, MACP, senior director for health quality and safety at Washington, D.C.-based MedStar Health and outgoing chair of the ACP’s medical informatics committee, and Sachin J. Shah, MD a general internist and health services researcher at Massachusetts General Hospital in Boston.

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“The perception for many of us today is that technology is toxic,” Basch noted. “We cannot go forward with new care models and consistently provide high-quality, high-value care unless the act of providing regular routine care doesn’t seem like competing in the Olympics every day.”

The ideal EHR

Basch outlined his vision of what EHRs that truly help physicians improve their performance and deliver better care would look like. To start with, he said, most patient data entry would be performed by someone other than the physician, either a staff member or the patient themselves, via a patient portal.

Next, EHRs would provide information in a form that’s easily understandable to the patient as well as the physician. “The big advantage of EHRs over paper is what you can display on it,” he said. “It’s the ability to pull things together in different ways, to answer questions like, ‘how is the patient doing over time with this new therapy?’ It’s not something you can do as well on paper.”

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Related to that is the need for EHRs to provide “accurate and actionable information,” especially in areas such as prescribing. EHRs rarely show what the final price of a medication will be to a patient, which makes it difficult for physicians to incorporate cost into prescribing decisions, he said.

A third element is what Basch called “anticipatory decision support”-providing EHRs with the ability to provide automatic help with ordering and treatment decisions based on a given stage ofthe patient visit. “We need EHRs that can anticipate our workflow. Something to remind us of things we forget when we’re multitasking,” he said.

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Finally, doctors need health IT that better incorporates non visit-based care-specifically, algorithms that can help determine how often a patient needs to be seen based on factors such as age, gender, disease burden and the medications the patient is taking. Such algorithm-based technology could be used even by solo or small-practice physicians, Basch noted.

Video visits pros and cons

Shah, in his presentation, focused on the pros and cons of video visits and e-consults. While video visits can be useful in supplementing in-person visits and enabling providers to get a sense of the patient’s home environment, “the reality is that even in the most integrated systems, video visits are difficult to implement and integrate into workflows,” he said. Moreover, video visits don’t provide the opportunity for a physical examination, ordering labs and other services normally provided in face-to-face care, leading to a greater possibility of diagnostic errors.

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“It’s difficult to understand how physicians in fee-for-service medicine will incorporate this into their practice,” Shah said.

The goal of e-consults, Shah explained, is to improve access to “rapid, direct, documented specialty care, and usually takes place within large health systems with common EHR systems. “It sort of formalizes the curbside consult,” he said.

The benefit of e-consults is the rapid response, usually within 24 hours. The downside, he said, is that the specialist isn’t examining the patient in person. “You’re getting some of the information very quickly, but a face-to-face consult provides a much more thorough view of the consult question,” Shah said. “So the tradeoff is, do you want some of the information fast, or all the information in a more traditional model?”