EHRs: Friend or Foe?

Physicians need intelligent systems. Physicians DO NOT need whiny, insecure, legacy systems that do little more than form the singularity of the documentation black hole that pines incessantly for their attention without returning value back. Sadly, physicians' relationship with technology in healthcare is the latter—a story of unrequited love where physicians sell their souls and get little support in return.?

The prime directive for physicians is of course the health of their patients, but they have to deal with technology systems with increasingly misaligned incentives. It’s no secret electronic health record systems (EHR) effectively failed to deliver anything more than a billing system, which insurance companies have been careful to exploit. The shell game of reimbursement, prior authorizations, and never ending documentation requirements have produced an environment toxic to physicians prime directive.?

One of the side effects of poorly incentivized technology systems is physicians falling out of touch with advances in medical knowledge and technology. This certainly isn’t purposeful; it’s survival. Physicians are currently spending up to half their time documenting patient encounters[1], they’re getting paid less, and there's a shortage of physicians; a recent study reported 1 in 5 physicians plan to quit.[2] How can we expect them to keep track of the massive amount of data and medical knowledge that is being produced??

We can’t; we shouldn’t.

EHRs promised simplicity, ease of access, advancement in medical practice, and improved patient outcomes. The reality couldn’t be more different. The EHR is currently a wasted opportunity falling far short of its potential. Instead of creating a companion technology for physicians, we’ve produced a parasite. The EHRs appetite for data is insatiable yet the mechanism for accessing and applying that data even within the confines of the EHR itself requires a comparative herculean effort.?

It’s no surprise to find out then that it takes on average 17 years for medical knowledge and research advances to translate from lab to clinical practice.[3] The fact that translation from research to practice is measured in years is mind-blowing. Forget years; two decades! This should incite primal indignation paralleled only by troubleshooting internet connectivity with your internet provider’s customer support (are you sure you don’t want to bundle?). The bottom line is the status quo is no longer sustainable and the evidence is overwhelming. Increasing healthcare costs, deteriorating standards of care, health disparities, and the pending exodus of physicians should be a wake-up call that things need to change.?

How?

EHRs have to become the epicenter of innovation in healthcare. Good platform building produces environments where stakeholders can create and solve their own problems using the platform's technology without involvement from the platform vendor. Current EHRs aren’t platforms, they’re anti-platforms stifling innovation, creating barriers, and hedging up paths to better health tech.[4–6] At the very bare minimum, we can’t continue to expect our physician workforce to care for patients while simultaneously performing mindless documentation tasks ripe for automation (think prior-authorizations).?

What we can do is produce technology that pushes information to doctors. Pushing information to doctors so they can leverage their knowledge to make wise decisions in caring for their patients is AI Medica 's mission. When EHRs seamlessly integrate evidence-based recommendations into the physician's workflow, automate mindless documentation tasks, recommend patients at high risk who need to be seen, and effortlessly and automatically track and report on patient population health trends, we will have succeeded.

References

1. Overhage JM, McCallie D Jr. Physician Time Spent Using the Electronic Health Record During Outpatient Encounters: A Descriptive Study. Ann Intern Med. 2020 Feb 4;172(3):169–74.

2. Abbasi J. Pushed to Their Limits, 1 in 5 Physicians Intends to Leave Practice. JAMA. 2022 Apr 19;327(15):1435–7.

3. Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011 Dec;104(12):510–20.

4. Mandl KD, Kohane IS. Escaping the EHR trap—the future of health IT. N Engl J Med. 2012;366(24):2240–2.

5. Mandel JC, Kreda DA, Mandl KD, Kohane IS, Ramoni RB. SMART on FHIR: a standards-based, interoperable apps platform for electronic health records. J Am Med Inform Assoc. 2016 Sep;23(5):899–908.

6. Mandl KD, Mandel JC, Kohane IS. Driving Innovation in Health Systems through an Apps-Based Information Economy. Cell Syst. 2015 Jul;1(1):8–13.