Survival of the 'Fitness' and Electronic Health Records

Janae Sharp
FEBRUARY 13, 2019
himss19,himss interoperability,himss ehr,ehr solutions
Photo has been altered. Credit: Oscar & Associates for HIMSS19

I miss my children when I travel for work. I also know that they are trying to tell my friend who is watching them that they are allowed to sleep on the floor in the living room and that they don’t have to do their homework. Their little 9- and 7-year-old agendas take over; my 9-year-old can convince people ridiculous things are true. When they are with a different person, they seem to enact a Lord of the Flies mentality, and suddenly I return home to a new fish or some other change. They constantly come up with their own adventures, telling the new person that this is how life always is for them.

Similarly, healthcare is telling people, “This is how things have always been done,” with patients and physicians none the wiser to the implication that all the problems are somehow intractable due to their longevity. Here’s the news I’m breaking in this story: That’s a lie.

>> #HIMSS19: How Can We Achieve Nationwide Interoperability?

I spoke with a few thought leaders about the issues surrounding the use of health records to ameliorate a broken system. It begins with a larger issue: Are physicians buried in meaningless tasks — or are physicians and other providers able to drive goals? As a chief medical information officer or informatics department has constant updates and improvements, are they actually improving their system over the long term or simply performing triage? In healthcare IT, are we buried under a pile of tickets or are we making our system better for patients and physicians? Our measures and our technology don’t always account for, or allow, what matters.


Repairing a Broken Healthcare System

It will take more than workflow management and empathic listening to repair the dissonance in our healthcare system. If our healers are more likely to have substance abuse problems and have higher risk of burnout — in large part due to frustration and dissatisfaction with the profession, made even worse by mountains of paperwork and lack of connection with patients — we must create a system where the healers are healthy.

Part of the problem is that no one wants to take responsibility. The other day, for instance, water spilled on my boys’ Xbox. When I caught up with them, they claimed this water summoned itself out of thin air. No one knows how the offending water made its way to an area where water is not allowed — but there was an incident, and now the health of the Xbox is in danger. No one is responsible.

The thing about not being responsible is, it usually means the people involved don’t want to change. When I look at healthcare, I see the same thing: “This is an experimental treatment, and I shouldn’t pay,” or, “This patient does not belong in the ER and we shouldn’t pay.” Or, “This patient doesn’t work enough to deserve Medicaid, and we shouldn’t pay.”

The thing is, no one has enough time, and no one wants to pay. Everyone seems to be holding up their hands and claiming, “This was not my responsibility!”

The focus is off. Do our measures in healthcare IT focus on how much water we are allowed to drop on the Xbox — that is, they actually measure whether we are improving patient and physician experience? Many people point their fingers at the payers, the ones paying the bill. Maybe it is the fault of the health records vendors for pushing through legislation that didn’t align with goals.

But let’s continue the metaphor: I bought the Xbox for my boys (which I subsequently threatened to throw out), so maybe I’m at fault for the water. If my insurance company could just improve my access, would my healthcare improve? I am not sure that it’s the people screwing up our payment possibility that hinders healing. I do know that every person has the potential to add to the good and contribute to better healthcare goals.


Can We Fix Healthcare?

One of the most important aspects of great customer service is ownership. When you hear a customer articulate a problem, own the problem. The Marriott organization trains their employees so that when a customer raises an issue, the staffers own the issue. You cannot pass the buck, and everyone agrees that the final goal is giving every guest a fantastic experience.

Have all of your experiences traveling reflected that goal? Do our healthcare systems reflect the goals we have? If we can focus technology on enabling ownership and meeting needs of each and every separate party involved, the finger-pointing won’t exist. We have enough resources and enough people who are willing to help to substantially improve patient outcomes and reduce costs. Technology is simply falling behind communication problems.

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One of those issues is the inviability of most electronic health records (EHRs) for the physicians who need to use them. I spoke with Don Woodlock, of Intersystems, who agrees that EHRs have a lot of room for improvement. “I do think that we have the ability to store the data that we receive,” he said. “Certainly, we like to think we have an awesome database for it with InterSystems — scalable, multi-model, vendors can store text, images, discrete data, etc.

“What’s tricky is putting the data to use in a way that is intuitive and useful,” he added. “The physician UX is still a big problem, as you know, when using in individual patient care scenarios. And getting the data in a form for data science, machine learning and population understanding is a significant challenge as well.”

Laura Adams, CEO of Rhode Island Quality Institute, put it nicely: “Physicians are looking for a needle in a haystack, and we IT people are just giving them more hay.”

Woodlock agrees that, in many cases, health IT needs to rebuild systems from the ground up.
 

“I think innovation does better with the natural forces of the market — survival of the fitness, so to speak. The problem with Meaningful Use is, you had a massive aberration in market forces as physicians and hospitals were interested in the subsidies, vendors were chasing regulations vs. direct customer-expressed needs, so you had adoption that took place faster than would have been natural without it.”


“I think that the natural market forces benefit the customer,” Woodlock concluded. “The power shifts to the buyer, and they will use what benefits them and ignore what doesn’t. It’ll be great if the market gets back to that.”


Why Good Health IT Is Important

Life-changing technology is the technology we want to adopt. EHRs will need to harness and use the same expertise and motivation that video games and social media platforms already prioritize. The more we understand motivation and need, the better technology adoption can drive health.

Remote clinics and large technology players that have avoided healthcare in the past now pose a risk to existing technology giants such as Cerner and Epic — the object in motion wants to remain in motion. Someday, the problem will be bad enough that the forward momentum will not continue. Whether existing players can meet the needs of the industry or new technology giants come in, the technology that “wins” will be the one that best facilitates accountability and cooperation. The problem to be solved may not yet be urgent enough to demand a change, but technology will drive the solution when we reach the breaking point.

That will occur, according to Woodlock, when physicians can be more productive with their healthcare IT than they are without it. The goal is to promote better patient experience and empowered clinicians, which he believes may already be happening.

“I firmly believe that we are on a journey that will end well,” he added. “We are certainly past the point where physicians would rather practice without an EHR. Having a more complete picture of the patient is just too valuable, that you never hear ‘let’s go back to paper.’ But we really must continue to journey and not rest for a moment. We must invest as vendors and as IT professionals within health systems to keep working until the usability and productivity is there for physicians and other caregivers. We’ll get there.”

Measures alignment and adoption following an overall vision will be the turning point for healthcare systems. Our goal is to facilitate healing with healthcare information and technology. Do your records systems enable patients to get the care they need and pay for it in a clear, straightforward way? Does the tech enable physicians to feel less overworked and have more time with the parts of medicine they find rewarding? That’s the ultimate goal, the sign that healthcare IT had been used successfully.

My children, however, will have to wait a few days before they use the Xbox again. No matter who was responsible for spilling the water, it’s time for a step back to evaluate the problem — and find a solution for water that materializes out of thin air.

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