Becker's Hospital Review

69 PRACTICE MANAGEMENT THOUGHT LEADERSHIP Dr. Nick van Terheyden: EHRs are Like Junk Drawers — But There's a Way to Declutter Them By Nick van Terheyden, MD, CMO, Dell Healthcare & Life Sciences S earching for patient data in an EHR is rather like rummaging in that catch-all drawer most people have in their kitchen. You know the one — it's where everything goes that doesn't have a designated place or somehow doesn't get put where it belongs. at drawer has many useful items in it. All those jumbled bits and pieces may be useful someday, but you don't need them right now. An EHR is a lot like that drawer. It has plenty of useful data in it, and a lot of other bits and pieces that, with the right inte- gration tools and the right analytics, will be useful someday. e problem is that right now you need a specific piece of patient data, and to find it you end up rummaging through a lot stuff that isn't of any help at the moment. Worse yet, the data you need can be a test result that is locked up in another system. It's like knowing that you have a small screwdriver that is perfect for the task at hand, but you loaned it to your neighbor. You could go knock on the door and ask for it, but they might take forever to answer the door, and then they'd have to rummage through their catch-all drawer to find it, and you just don't have time to mess with it. So you buy a new one. Like that screwdriver, the data you need is oen locked up in another nearby system, and you could get it if you asked for it, but you don't have time to knock on the digital door and wait around for the other system to find it and send it to you. So you order a new test. A better way to rummage in the digital data drawer To take the analogy a bit further, imagine that you hire an organizational assistant to sort all the stuff in the catch-all draw- er, pull out the bits that are currently useful and place them on a shelf, neatly organized and easy to find. And the assistant sets up a network with your neighbors that tells you exactly where all their useful bits are, and places those useful bits in a place you can access easily. And then he sets ups a drone system to bring those useful bits to you whenever you needed them. at would be pretty amazing, don't you think? It is possible to create a digital organizational assistant to rummage through the EHR and present you with the data you need just when you need it. ere are several developers working on new interfaces for EHRs, which would treat the EHR like a relational database rather than a clinical user interface. e new interface would gather data from the EHR and send data back to it, but would present the physician or other caregiver with an interface specifically designed for that clinician and his view of patient care. Currently, EHRs are gathering all sorts of data that is useful for billing, analytics, population health risk stratifi- cation and other purposes. But oen that data isn't useful for re- al-time patient interactions, and the interfaces are less than ideal. It's no secret that physician dissatisfaction with EHRs is high (there's even a rap song about it). [Editor's note: See "New Music Video Puts EHR Woes to the Tune of Jay-Z," on beckershospital- review.com.]But with billions invested in existing applications, it's unlikely that hospitals, health systems and physician practices are going to make a major change any time soon. And EHR vendors don't have any real incentive to do the kind of overhaul of their applications that physicians really want. is "digital assistant" approach will eliminate much of the frustration of dealing with EHRs, while making good use of the existing investments. And if the right integration tools were in- corporated into this interface, it could conceivably rummage through other EHRs, pharmacy systems, emergency department systems and other clinical applications in real time to find all the useful data and present them to you in a way that is relevant to the patient and the clinical decision-making process. Here's an example of how that would work. Let's say you are a primary care physician and you have a diabetic patient, Mrs. Johnson, who goes to the ED on the week- end because of a fall. If your digital assistant sorted through the EHR systems of all local EDs daily and pulled information about your patients into your system, you would know that Mrs. John- son had an incident that could be related to poor blood sugar control. Did she fall due to dizziness or faintness? Is she having issues with her arthritis? Is she developing a heart condition? If your digital assistant also pulled in Mrs. Johnson's blood "The data you need is often locked up in another nearby system, and you could get if you asked for it, but you don't have time to knock on the digital door and wait around."

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