The Future of Patient Data

The Future of Patient Data

As a medical scribe, my sole purpose is to assist physicians in documenting patient visits along with other administrative tasks so that they can reduce their time on screen and focus on making meaningful connections with patients. When I first encountered the electronic health record (EHR) system in my training, it felt overwhelming. I couldn’t understand why it was such a difficult system to navigate and at times counterintuitive. Now that I’ve been using it for almost a year now, I’m more confident in using the system, but I think it has potential to improve.

Medical records have existed since 1600-3000 BC when Egyptians first documented in hieroglyphics on papyrus. Paper medical records became much more common between 1900-1920. A push to start integrating the EHR system into the medical community began in 1992 due to greater ease of use and accessibility. The initiative was met with resistance due to high costs, potential data entry errors, and poor physician reception. It also raised ethical questions such as data control and patient dignity. However, as technology became more advanced and affordable, the EHR system was gradually established in hospital systems around the world [1].

EHR systems have helped improve patient care by providing comprehensive health histories of patients for physicians and other healthcare providers, easier accessibility to medical charts, and more precise care. Patients are also more involved in the process and have greater access to their personal records through programs such as MyChart [2][3]. But has the EHR system lived up to its initial hype? In one study published in The American Journal of Emergency Medicine, it was shown that electronic charting took 30% longer than paper charts and that documentation in general took up 30-40% of a workday [4]. Not only is it a productivity issue, but the EHR system has also led to data entry errors. It has become increasingly common, especially in fast-paced emergency rooms, to accidentally order the wrong medications or miss key patient information [5]. There is also the “cut and paste” problem in which erroneous information is cut and pasted again and again in patient records. These types of errors are risky particularly because errors can affect patient treatment. Some physicians have become fed up with the complexity of the EHR system and think they are more like data entry clerks. They only spend 27% of their time with patients and even while in the room with patients, they spend up to 37% of that time looking at the computer. On top of documentation, they also have “to report a series of quality measurements, provide proper insurance coding, and introduce more legalistic wording into the EHR to prevent lawsuits.” [6]

Fortunately, there are plenty of initiatives being implemented to improve the current EHR issue. The main issues that need to be addressed are better accountability for human error [5], interoperability between EHR systems [6], better design, and a simpler interface. Of course, scribes can be used to increase physician productivity, but this is only a band-aid to the problem. Health startups such as CareCloud [8] and Practice Fusion [9] address a few of the current issues and provide alternative EHR systems. However, it would be difficult to make yet another transition to other types of EHR from already established ones such as Epic Systems, Allscripts, and eClinicalWorks [7]. Another innovative startup, Drchrono, is developing an application integrated into Google Glass that will allow physicians to record a consultation with the patient’s consent and automatically store notes into a patient’s medical record [10]. New technology currently in development by Google Brain could replace medical scribes all together. Computer software algorithms would be able to listen to a physician-patient conversation and dictate it into the electronic medical chart using proper medical terminology [11].

Digital medical records are a complex issue that require more collaboration between healthcare and technology experts. Current EHR systems are consistently not meeting physician and patient needs and there needs to be more flexibility in the system to allow for a better experience for everyone. Despite the many flaws of the current EHR system, there is merit in its use and its potential for the future. Multiple disciplines have instant access to patient data in real time. Physicians and patients have greatly benefitted from this technology and will increasingly depend on it as time goes on. Several groups have taken on this arduous task and have provided promising alternatives that could potentially shape the way physicians and patients interact with the EHR system. Healthcare delivery will be greatly affected by the efforts put into this expanding market.

References:

  1. Evans, R.S. “Electronic Health Records: Then, Now, and in the Future.” IMIA Yearbook of Medical Informatics 2016. 20 May 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5171496/

  2. “What is EMR?” USF Health, accessed 19 June 2018. https://www.usfhealthonline.com/resources/key-concepts/what-are-electronic-medical-records-emr/

  3. Harmon, Katherine. “The Future of Your Medical Data.” Scientific American. 12 April 2010. https://www.scientificamerican.com/article/future-of-medical-data/

  4. Hill Jr. MD, Robert G., et al. “4000 Clicks: a productivity analysis of electronic medical records in a community hospital ED.” The American Journal of Emergency Medicine. November 2013. https://www.ajemjournal.com/article/S0735-6757(13)00405-1/abstract?code=yajem-site

  5. Luthra, Shefali. “Electronic Health Records in ERs Causing Medical Errors.” KQED Science. 03 March 2016. https://www.kqed.org/futureofyou/122266/electronic-health-records-in-ers-causing-medical-errors

  6. Gorn, David. “These doctors think electronic health records are hurting their relationships with patients.” PBS News Hour. 21 July 2017. https://www.pbs.org/newshour/health/doctors-think-electronic-health-records-hurting-relationships-patients

  7. “Healthcare Professional Health IT Developers.” The Office of the National Coordinator for Health Information Technology. July 2017. https://dashboard.healthit.gov/quickstats/pages/FIG-Vendors-of-EHRs-to-Participating-Professionals.php

  8. CareCloud, accessed 19 June 2018. https://www.carecloud.com/

  9. Practice Fusion, accessed 19 June 2018. https://www.practicefusion.com/

  10. Farr, Christina. “Startups, Entrepreneurs Try To Solve Medical Records Debacle.” KQED Science. 13 March 2015.

  11. De, Monya. “Can Google save doctors and patients from the misery of electronic medical records?” USC Annenberg Center for Health Journalism. 26 January 2018. https://www.centerforhealthjournalism.org/2018/01/23/can-google-save-doctors-and-patients-misery-electronic-medical-records

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