05/25/2018

Bringing Electronic Health Records Into The Modern Age

4:56 minutes

doctor touching tablet on desk
Credit: Shutterstock

In recent years, medical providers have largely moved away from scrawled paper charts to electronic health records—a  switchover spurred both by a 2014 federal mandate and by the promise of better record-keeping, sharing of records, and portability. But writing in the New England Journal of Medicine, a team of researchers argues that the transformation of medical records hasn’t gone far enough.

While there has been widespread adoption of electronic health records, most are just static, flat translations of the format of the old fashioned paper file. If we can subscribe to specific categories of news online, the researchers say, why shouldn’t medical specialists be able to subscribe to a given patient’s medical records to get updates and alerts of specific interest to them? Why shouldn’t medical teams be able to get notifications and share information when patients needing special care plans arrive at the hospital?

[For some satellites, it’s all in the (Miura) fold.]

Dr. Katherine Choi of the Penn Medicine Center for Health Care Innovation joins Ira to talk about ways that electronic health records could be improved.


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Segment Guests

Katherine Choi

Katherine Choi is a clinical innovation manager at the Penn Medicine Center for Health Care Innovation in Philadelphia, Pennsylvania.

Segment Transcript

IRA FLATOW: And now, it’s time to play Good Thing Bad Thing.

[MUSIC PLAYING]

Because every story has a flip side. Now in recent years, medical providers have largely moved away from their old paper charts. They’ve moved to electronic health records. And the switchover was spurred in a large part by a 2014 federal mandate, But also by the promise of better record keeping, sharing of records, and, of course, portability. You can put a thumb drive in your pocket if you want, making it easier to move your records from one provider to another.

Joining me now to talk about those electronic health records, EHRs in industry speak, is Dr. Katherine Choi. She’s at the Penn Medical Center for Health Care Innovation and co-author of a perspective article in the New England Journal of Medicine. Welcome to the program, Dr. Choi.

KATHERINE CHOI: Hi, Ira. Thanks for having me.

IRA FLATOW: You’re welcome. So what’s the good news on electronic medical records?

KATHERINE CHOI: You’ve got it right. I think in the past 10 years, there’s been a huge shift where almost all hospitals are now instead of using paper charts, using electronic health records. And that means we avoid the mistakes that were caused by illegible handwriting, where doses were misread, or the shorthand was misinterpreted. And the chart no longer lives in one place, and it can be accessed remotely.

And now, vendors are actually starting to share data between them so you can see more of the whole picture of the patient in front of you, the overall thing.

IRA FLATOW: Yeah. And this has been really hyped very widely for years now. Has it turned out that way, or is there some bad news to this?

KATHERINE CHOI: It was definitely a first big step into getting health care into the digital world. But in its wake, though, we see the rise of burnout. And physicians cite EHRs as contributing to the burnout they experience on the job, and because there’s a gap between what they need and what they’re able to do with their electronic health record.

We think that what many institutions have now achieved is closer to transcription of taking those paper charts and making a digital counterpart. But the transformation that we really needed was to move away from a model that was such a passive process, where providers had to go to the chart repeatedly to see what had changed, what was new, what was missed, and what was awry. And so instead, we need to move towards a model where the most important information comes to them. Yeah.

IRA FLATOW: So has this become, like, the supposedly paperless office, where there’s actually more paper than when we had paper? I mean, are we creating more work than we had before, it sounds like?

KATHERINE CHOI: It’s tough to navigate. I think there’s a lot of information in these records. And now, the tough part is that physicians and providers have to grapple with is, how do they know what’s there? So the biggest opportunity’s to find out how we can help them act on some of this information at the right time. That means reimagining electronic health records, I think, to be something more dynamic and responsive.

IRA FLATOW: What does that mean in real speak? In other words, what would I see differently happening? What’s the solution here?

KATHERINE CHOI: Yeah. I think that means designing with clinicians to see, what do they wish they could know? A lot of these things require some action on their part, so making sure that they’re aware at the right time and this is getting the right person to know the right thing at the right time. And we use the model thinking they’re more like feeds or channels that you subscribe to in the same way that they’re subscribing to feeds and the rest of their lives to follow friends, or their favorite sports teams, or the price of bitcoin.

IRA FLATOW: This sounds like artificial intelligence might be really useful here to help [INAUDIBLE].

KATHERINE CHOI: I think that’s a component. In some ways, it could be simpler than that. Right now, most clinicians, I think, are trying to do everything that they need to do. And they’re sifting through the charts and trying to find out and stay on top of everything. So it’s maybe as simple as working with them to design some of these custom channels. And then I think down the line, AI can help offload some more of that.

IRA FLATOW: Would it be a danger, though, that I get too many alerts. I can’t keep up with them. My watch keeps going off, you know?

KATHERINE CHOI: Yeah. Alert fatigue is real, and it can be self-defeating. So I think what we’ve seen is that it takes really careful design and a design process. So our team of hybrid clinicians and developers partner with our providers to come up with a first rule of what they think might be helpful. But we test it in the wild and make sure we tweak it within a couple of days or weeks until we get it right. And I think it’s our process that’s really made a difference.

IRA FLATOW: Do you think you’re going to get it right?

KATHERINE CHOI: I think so. It’s going to take some work. Yeah, that’s exciting.

IRA FLATOW: Doesn’t everything?

[LAUGHTER]

Well, have a happy– happy holiday weekend to you.

KATHERINE CHOI: Thank you. You too.

IRA FLATOW: Katherine Choi, clinical innovative manager at the Penn Medicine Center for Health Care Innovation. That is, of course, in Philadelphia.

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