Patient Subscriptions May Enhance Future of EHR

A new viewpoint argues that the Electronic Health Records (EHR) can be restructured from mere digital remakes of pen and paper ancestors into platforms that allow doctors to subscribe to their patients' clinical information, similar to social media feeds.

Researchers from the Center for Health Care Innovation at the University of Pennsylvania (Penn; Philadelphia, USA) argue that EHRs, once hailed as essential to the advancement of health care into the 21st Century, have resulted in increased rather than decreased physician work load, contributed to physician burn out, and returned little back to patients in improved health care quality. In contrast, the researchers point to several examples implemented within the Penn Health System that reveal how record systems can be reconfigured into subscription services.

One such example is how Penn established automatic medication expiration dates for antibiotics and antiepileptics for inpatients, but with a system that initially required physicians to remember when to renew the expiring prescriptions. As a result, medications were not ordered 10% of the time because physicians did not check the chart in time or notice the need for renewal. To address this, Penn created a web application that among other features, allows residents to receive push notifications on their mobile devices – the number of missed renewals was cut by one-third.

Such push notifications can also shorten the lag time between when information becomes available and when it's used. An older approach at Penn waited until morning rounds were over to evaluate whether patients on ventilators in the intensive care unit (ICU) could breathe without assistance. Digital data now enables patients to be automatically evaluated and clinicians to receive prompts to act when patients meet the readiness criteria. The new process has reduced delays so patients spend, on average, half a day less on ventilators.

Another program at Penn monitored the 30 patients with the highest use of care in one of its hospitals, using a dashboard to follow their needs, such as the best way to communicate with them, engage with their family, and setting up social services. A multidisciplinary team was automatically alerted to such a patient's arrival in the emergency room and pointed to the action plan in real time. One year after implementation, 30-day readmissions and total days in the hospital for this group of patients decreased by 67% and 56%, respectively. The Perspective was published on May 24, 2018, in the New England Journal of Medicine (NEJM).

“When the first movies were made, they were really just plays made permanent on film. It took time before film editing and special effects turned the two dimensional images on the screen into something more immersive than what could be performed on stage,” said senior author David Asch, MD, MBA, executive director of the Center for Health Care Innovation. “Current EHRs haven't taken the step they need to. They are still just putting plays on film. Health care is suffering today in part because health records haven't yet made the transformation that nearly all other industries have achieved as they have gone digital.”

“We need to move beyond passive engagement with the medical record to the approach people expect in other parts of their lives, that important information comes to them,” said study co-author Katherine Choi, MD. “The same doctors who, on their way into work, are getting news feeds on their favorite sports teams, still have to 'go to the chart' to check up on their patients. If you can subscribe to feeds about a football team, why can't you subscribe to Mrs. Jones in room 328?”

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