The administrative burden of medicine significantly contributes to physician and clinician burnout, electronic health systems, or EHR system design and workflow as a lead culprit. As such, recent EHR technology innovation tactics have focused on automating components of data entry and documentation. These technology innovations could significantly reduce the amount of time we spend crafting our SOAP notes and documenting patient encounters.
While the focus on improving documentation can be commended, our efforts to improve information exchange and build highways of interoperability create a different kind of challenge related to comprehensive chart review.
In the time of paper charting, patient records were limited and selective to specialty-specific pertinent information that was housed in a filing cabinet at the physician office. Eventually, the comprehensive and cross-continuum EHR systems have evolved to provide electronic inpatient, ambulatory, ancillary, and pharmacy record integration. Health information exchange (HIE) efforts have built highways of information sharing opportunities that add more health history and data points to the patient record. Lastly, remote patient monitoring gadgets and the IoT (Internet of Things) will evolve and integrate with EHR systems to add real-time data and information to patient records.
What was once a few pages in a manila folder is now a massive accumulation of patient information stuffed into a complex multi-level “electronic filing cabinet” with inconsistent configurations across healthcare institutions and unique device-specific data integration challenges. As clinicians, we are tasked with combing and mining the patient records in search of pertinent information prior to engaging in our fifteen minutes of direct patient care. As a result, we currently spend 33 percent of our time outside of patient encounters in chart review activities and suffer significant cognitive load due to charting burdens. We click and toggle our way to stitch and weave a clinical patient story together and make efforts to meet patient expectations of reviewing their chart.
On a recent audit of the number of “pages” in an electronic patient chart, I counted approximately 1,000 for a straightforward patient and over 3,000 for a medically complex patient. This was after eight years of patient record accumulation in the current EHR system that did not include next-generation external device integration or complete HIE highways to all health systems in the area.
The famed biologist E.O. Wilson says, “we are drowning in information, while starving for wisdom. The world henceforth will be run by synthesizers, people able to put together the right information at the right time, think critically about it, and make important choices wisely.”
I wholeheartedly agree, with a slight difference. The sheer magnitude and volume of patient information now readily available and continuing to accumulate is unsustainable in the current model of care, and we cannot only depend upon people to solve this challenge. We need to design technology solutions to facilitate our pursuit of aggregating data point “needles” in information “haystacks.” By integrating technology innovations with our human potential, we can optimize our ability to synthesize information and promote wisdom. Without smart technology solutions on the forefront, what will a chart review entail in the year 2030?
In addition, we need to engage patients in better understanding the realities of the data challenges we face as clinicians and our ability to review everything in their health records comprehensively. Engaging patients in taking ownership of their own health data and allowing them to facilitate in telling their story could be a path forward to collaborating, reducing risk, and jointly owning the patient intake process.
A recent article from the AMA cited eight priorities to reduce physician burnout related to EHR optimization. Two of the top opportunities specific to technology innovation include lessening cognitive workload through augmented intelligence solutions and promotion of data liquidity to optimize interoperability and reduce repetitive data entry and data mining activities. Focusing on these two areas of innovation can significantly reduce the amount of time providers are spending in pursuit of chart review, reduce burnout, and allow us to spend more time with our patients. These priorities should be guiding principles and set the framework for continued optimization and innovation of the EHR for a pathway forward.
Eve Cunningham is an obstetrician-gynecologist.
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