Issue link: https://beckershealthcare.uberflip.com/i/977748
70 THOUGHT LEADERSHIP CMIO musings: The ideal EMR — A wish list By Maulik P. Purohit, MD, Senior Vice President and CMIO, University Health System T he EMR is both a blessing and a curse. It offers some conveniences, such as remote charting and automation of some workflows. However, it's another piece of healthcare technology that largely does not take the end user into account. is causes distractions for healthcare workers and reduces important rapport building with patients. In its current form, the traditional EMR is clunky and difficult to use. It requires many clicks to get the end user where they want to go, and applications can't always leverage data inside the EMR to deliver the most optimal results. For example, when you compare current industry-standard EMRs to Google, which pulls together data from across the internet, it becomes obvious health IT products are behind. e user experience is completely different. e EMR's programs aren't always integrated. It is a conglomeration of apps thrown together and a diverse series of login credentials. In one facility, there may be multiple EMRs targeting different departments. With Google, I can seamlessly go between my email, the internet to find directions to an Indian restaurant, YouTube to watch videos and all my photos — without ever reading an instruction book or attending training. Let's just say the traditional EMR system doesn't have the same level of imagination. Rethinking the EMR A successful EMR combines operations — clinical, financial, etc. — during the IT design, not aer. Some vendors already do this by keeping the physician in mind when building products. However, vendors should solicit input from all end users — including nurses and pharmacy staff — at all levels of product development. e most successful vendors also involve the hospital's IT team. at way, the IT department understands clinicians' workflows and how they want to interact with the EMR. But, the onus isn't solely on EMR vendors: Healthcare organizations must also step up to the plate if they want to see positive changes in the EMR space. A hospital system that considers the EMR as simply an IT product instead of an operations product is setting itself up for failure. An EMR wish list Here are six things all EMR vendors should consider incorporating into their soware. 1. The EMR should understand the data it stores. Data entry is one of physicians' and nurses' top pain points in regards to the EMR — but it doesn't have to be. Automating processes and assisting clinical personnel better would make EMRs more user-friendly. However, the EMR must go one step further to be intuitive. For physicians to reap its full benefits, better data integration is a necessity. is means the EMR should be capable of analyzing patient data to identify patterns or gaps in care, predict outcomes or advise treatment plans. It should also be able to take in patient-generated health data to paint a clearer picture of individuals' unique health circumstances. Google and Amazon, for better or worse, oen know what your preferences are before you do. e EMR should get to this level. 2. It should be wholly interoperable. An EMR that can connect an organization's departmental EMRs and enable cross- organization communication and collaboration is a must. is data sharing should extend beyond the four walls of each organization. e healthcare industry has grappled with interoperability for years. It is time to put patient needs ahead of our business desires, as this is effectively a patient safety and healthcare waste issue. 3.Machine learning and artificial intelligence should address hospital needs, including infrastructure and population health concepts. Given our current abilities, we should be able to improve staffing in the emergency department using predictive analytics based on historical information regarding weather patterns, time of year, city events and more. We can even better equip the EMR with AI capabilities that could ease some data entry burden, provide better decision support and improve patient outcomes. For example, alert fatigue is a significant barrier. AI could provide more "intelligent" alerts to support physician decision making rather than the current shotgun approach. Furthermore, an EMR that features voice recognition or autopopulation would drastically decrease the time it takes physicians to complete notes. From a population health standpoint, an EMR with AI could potentially identify specific factors affecting a subpopulation of patients with diabetes and provide more targeted treatments than the standard guidelines, or it could better identify suicide risk factors and provide treatment suggestions before it is too late. 4. Cloud storage is a plus. e cloud is not new — it's been used to store emails and files for years — and only shows signs of expanding, which is why it's time to start hosting health data on it. Not only is it cheaper, but it can enhance security, convenience and accessibility. Outsourcing data hosting to a cloud vendor opens up valuable hospital IT resources. While organizations considering a move to the cloud oen fear they'll give up control of the data to cloud vendors, it's not always the case. In fact, if all vendors hosted on the cloud, organizations would be able to pool data from multiple hospitals to support true population health. 5. Open notes would ensure stronger patient-physician relationships. Giving patients full access to their EMR not only empowers them, but also engages them in their care. An EMR that enables easy patient access and data entry would lay the groundwork for stronger patient-physician relationships by establishing patients' trust and building greater interest in their health. Of course, caution should be taken here, such as in cases of mental health or domestic abuse, to protect individuals and ensure they are kept as safe as possible. 6. The EMR should incorporate patient- generated data. e wave of the future is the patient biometric devices that can give us greater insights into patients' whole health. For example, we used to diagnose and treat hypertension on a few readings every few months. Now we can have real-time data. is allows us to improve treatment and reduce overtreatment, which is equally dangerous. Reviewing patient -generated data also shows what aspects of patients' care plans need to be refined. e step count on a Fitbit could indicate a patient needs to exercise more or that they need to switch up their workout regime. e Apple Watch shows promise of identifying irregular heart rhythms, like atrial fibrillation. e EMR of the future should function the way Amazon, Google and others work — by taking data and turning it into meaningful and actionable knowledge in an intuitive and enjoyable method. is vision is not asking too much when we see the other IT products out there. Healthcare needs to get into the 21st century! n