This post is an insightful Q&A with Greeley’s Senior Advisory Consultant, Kim Wilson, MS, BSN, RN.
Q: Do you think electronic health records (EHRs) are clinically useful?
A: There’s a lot of factors that contribute to the usefulness of an Electronic Health Record (EHR). Overall, we’ve come a long way from the old paper charts that often hid out among nursing units, medical records departments, physician dictation cubicles, patient stretchers, operating rooms…and so on. Gone are the days of standing in line, waiting to gain access to the patient’s medical record while another discipline thumbed through page after page of a 3-inch paper chart. Now, clinicians can concurrently view the record at any given time whether it be on a nursing unit, in a dictation room, or in the comfort of a recliner in their home. Advances in technology have made accessing clinical records so convenient that many healthcare providers would be truly lost in a paper world.
However, no amount of access will be clinically useful within the confines of a poorly designed EHR. Consistently, one of the biggest hurdles healthcare organizations face is overly complex and burdensome EHR. It appears that we’ve swung the pendulum from a very minimalistic paper record to an EHR that makes navigation almost impossible for providers. As a healthcare informaticist, I caution organizations all the time that “bigger is not better.” For those in the industry, we know there are the beasts of the EHR world that boast of interoperability, a multitude of dashboards, and ease of navigation. In reality, most clinicians will chart the bare minimum and abuse copy/paste functionality due to poorly designed and cumbersome EHRs. These poor designs usually stem from a false belief that compliance can be achieved through the utilization of an EHR. I preach this message to every client I encounter attempting to force “good care” through an EHR, “You will never succeed at obtaining compliance by forcing documentation.” Healthcare providers are not wired to be slaves to a computer. They are wired to provide the best care they can. The reflection of that care in the EHR is just a by-product of the overall process.
Ultimately, EHR systems can be very useful to clinicians, but there must be a lot of thought and consideration into the design and implementation of the system for it to be truly useful.
Q: What is the biggest clinical use case for EHRs?
A: I’m sure most people would say the best clinical use case for an EHR would be capturing structured data that can be used to data-mine and predict outcomes. While I don’t disagree with this, this concept has spiraled out of control so much so that I find organizations “collecting data for the sake of collecting data.” There’s a plethora of information being captured in the record, but very little is being done with it. Dashboards, queries, and reports can be very useful for retrospective analysis and occasionally as a predictor tool. However, I’ve rarely seen action taken from the enormous amounts of data collected in real-time – when it would matter to the bedside nurse, practitioner, or more importantly, the patient.
So, understanding the burden providers face, the biggest clinical use case for an EHR would be to have the necessary information available in real-time that would help determine the best treatment modality for the patient. It’s as simple as that. There needs to be a clear and easy representation of the patient’s current condition (vital signs, lab work, radiology exams, etc.) without the clutter of superfluous information that currently exists. Additionally, this information needs to be easily accessible without the pain of “a thousand-clicks.”
Q: What problem — if fixed — could help providers extract more value from EHRs?
A: EHR vendors and healthcare organizations need to have a better understanding of what documentation is actually required from a regulatory standpoint. As an example, a normal admission assessment for a patient entering an inpatient unit can range from 50 – 300 questions, depending on the hospital and EHR system. In reality, there are very few federal requirements pertaining to information that must be collected upon admission. On average, I recommend eliminating 50-70% of admission documentation as it’s excessive and overly burdensome for nursing staff. More importantly, it’s not required. Despite this, admission assessments continue to grow, and nursing dissatisfaction follows suite.
Ultimately, simplification is key. Healthcare organizations need to dial back down requirements and eliminate the “fluff” in their medical records to ensure that anyone who views a patient’s record can “see the story.” Because overall, we’ve lost that patient story.