EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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A secret shopper’s perspectives on the EHR and clinical workflow 

A secret shopper’s perspectives on the EHR and clinical workflow  | EHR and Health IT Consulting | Scoop.it

As someone who has practiced medicine using both paper and electronic records, and someone who's been focused on the health tech scene for the past 20 years, you might think I've seen it all. Indeed, during my 35 year career in medicine and tech I've traveled the world and learned a lot about healthcare, clinical practice and the intersection between medicine and technology. However, there's nothing like being a secret shopper to get a little reality check on where things stand with electronic health records and clinical workflow.

 

For the past couple of months, and likely continuing for most of the next year, I am charged with helping a family member through treatments for an all-too-common medical problem--cancer. That means I am accompanying my family member through diagnosis, surgery, chemotherapy, radiation therapy, and eventually medical monitoring and follow-up. Let me tell you, there's nothing like being in the trenches of a patient care experience to see how far we've come, and how far we still need to go to fix healthcare.

The hospital and health system we are visiting uses one the major EHR solutions. However, even within the same institution, departments seem anything but connected. When we have multiple appointments on the same day in different departments, we are still filling out paper forms asking the same questions in every department we visit. Worse yet, even when we make our second or third visits to those departments we are again presented with forms to fill out. Wouldn't it be better to fill out that information on a tablet device or kiosk and make it available to all departments at once? Wouldn't it be better on subsequent visits for us simply to review the information on an electronic screen and edit or update it as needed? Where's the single version of the truth?

 

In the exam room I've noted how much time clinicians and support staff are spending in front of the computer, rather than with the patient. The only doctors not doing this are the super-specialists who foist most of that burden on scribes or other members of their support staff. Furthermore, the computers in the exam rooms are mounted to a wall or sitting on a counter, often forcing the user to have his or her back to the patient. Clinicians must assume a kind of sideways posture with head bobbing back and forth between the machine and the patient. Where are the mobile devices--the laptops, tablets, and smartphones? Has anyone really given a thought to the importance of mobility in clinical workflow?

Then there's the clinical user interface that looks like it came from the dark ages. It took one of our providers about ten minutes just to key in an order for a durable medical supply and print it out for our insurance company. The user interface to the institution's patient-facing portal is equally bad. A web-savvy teenager could likely do better. Today's portals need to look and work more like Facebook or LinkedIn than something from the dawn of the Internet.

Another inefficiency I have observed isn't so much about bad tech as stupid billing mandates. Even when visiting different physicians in different departments on the same day, during each visit staff enter the exam room to take and document vital signs. Over and over again the thermometer and blood pressure come out, even though vital signs were just taken and documented 30 minutes ago in a different department. I finally asked why this was necessary only to be told that unless it is done the physician will not be paid. Has anyone considered what this totally unnecessary and duplicative workflow is costing our hospitals and health systems in wasted staff time? Let's stop the insanity.

By now, I'm sure you are thinking I've grown old and crotchety. I probably have. But please future generations of software developers, EHR vendors, regulators, and others; can't we do better for our clinicians and patients? I'm sure we can.

If you would like to become more familiar with the work Microsoft is doing in health and the healthcare industry (in cloud computing, mobility and devices, productivity and collaboration, and advanced analytics) please contact your account executive or visit Microsoft in Health.

Bill Crounse, MD      Senior Director, Worldwide Health         Microsoft 

Technical Dr. Inc.'s insight:
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Can Human-Centered HIT Design Improve Patient Engagement?

Can Human-Centered HIT Design Improve Patient Engagement? | EHR and Health IT Consulting | Scoop.it

Patient engagement is a hot topic in the healthcare industry today and the federal government is pushing forward patient-centered care through meaningful use regulations. However, the question remains: how do providers engage their patients more in their physical health? Are basic patient portals enough?


EHRIntelligence.com spoke with Shaun Gummere, Chief Design Officer at Story+Structure, to learn more about human-centered health IT design for the healthcare sector. Gummere explains that his company focuses on finding new ways for organizations to create human relationships.


During the interview, the design of human-centered patient portals was discussed and Gummere mentioned the importance of developing a “natural and intuitive” method for increasing health literacy. Currently, the design of patient portals is not effective enough to truly engage the patient, the Chief Design Officer explains.


“When I think about a patient portal as it’s currently conceived, it’s an afterthought that arises from checklist requirements,” Gummere said. “When I think of an electronic engagement with your provider, it is much more about the question of ‘why?’”


“When you look at why people don’t take the medication they’re prescribed, they feel disconnected from their provider. They listen when they’re in an acute care setting, but when they go home, they don’t have that voice and that guide with them.”


He goes on to explain that patient portals provide bi-directional communication and the inclusion of mobile health technology can help patch the gaps found when patients leave the doctor’s office.

Additionally, Gummere spoke about restructuring the tools used today to improve medication and treatment adherence among patients. Most EHR systems, he explains, are more technology-based and include too many data dashboards and codes, which puts a significant administrative burden on healthcare professionals.


Patient engagement is low because doctors don’t have time to make eye-contact as they’re entering data into EHRs. Gummere said it is vital to discover the engagement process between providers, tools, and patients before installing a new system.


“EHRs to date have been a technology-first initiative. The goal was get an EHR and we’ll find out later where the cost savings arise,” Gummere explained. “Today I think it needs a complete rethink. We need to do some deep research and observation of what people really need.”

“How can you make the relationship between the healthcare provider and the patient more present?” Gummere asked. “I would look beyond what a portal is currently conceived of. The human-centered design process is really one that takes a very divergent view and… gets very deep into human contact, human behavior and human motivation.”

When asked about some of the most important features to include in a patient portal or other patient engagement tools, Gummere spoke about how these technologies need to be intuitive and easy to use among patient populations. He also went on to explain the benefits of mobile and wearable technology in the healthcare setting.


“It needs to be attractive, intuitive and as simple as possible. There’s some phenomenal opportunities as we start to look at mobile and also wearable. I think that’s going to be a huge trend for the next five years and there’s going to be a tremendous amount of innovation there.”

“Healthcare practitioners need accurate data. Asking the patient to be an administrator is often extremely difficult,” Gummere said. “If you look at wearables to be your supplement and supporter to deliver that data. It’s almost like you have your own assistant.”


When asked about some of the ways human-centered EHR systems lead to better patient engagement, Gummere spoke about the importance of observation and research aspects of designing these type of technologies.


“One thing to know about our design process is that it begins with observation and then we hypothesize. We essentially frame an opportunity,” Gummere stated. “If an EHR provider were to hire us, we would do a great deal of research. We would think about the people who need to use it and try to understand their context.”


“Once we have the hypothesis, we do prototypes. Prototypes are a test of what we think may lead to greater engagement. That test goes through a number of reiterations,” he continued. “We like to go through a design process using co-design. That could be bringing doctors and nurses for an afternoon session … [and] bring patients into the room to get everyone talking.”


When asked whether Gummere believed Stage 2 Meaningful Use requirements are leading to better patient engagement and human-centered design, he answered: “Absolutely not.”


“What I see there is well-intentioned bureaucracy trying to ensure that the investment being made is used. It’s a fine sentiment but it reminds me of implementations that lead with technologies or lead with a checklist idea. It’s a top down approach. I think the people-first approach we’re advocating would be ideal.”


“How can patients own their own wellness or care?” Gummere asked. “That’s not going to be addressed by a checklist approach. It’s too minute and too specific and it’s missing the ‘forest from the trees.’”

The Chief Design Officer also spoke about the capabilities that telemedicine and current trends in the healthcare sector have for improving patient engagement, the doctor-patient relationship, and the overall practice of medicine.


“It holds great promise,” Gummere stated. “A lot of the moving parts need to be refined but I think telemedicine is incredibly promising because it would help people attain well-being, attain health, and co-own their own care.”


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