Making EHRs High Tech for Real-Forbes Healthcare Summit 2014

This years’ Forbes Healthcare Summit brought together Paul Black (Allscripts), Jonathan Bush (athenahealth), Robert Robbins (Texas Medical Center), Richard Rothaman (The Rothman Institute) and Erin DuPree (Joint Commission Center for Transforming Healthcare) to discuss healthcare informatics in medicine.

Erin DuPree started the conversation with the statistic “in a period of three and a half years there were 120 healthIT related incidents reported in the Sentinel Event Database recorded by The Joint Commission. The Sentinel Event Database records when preventative harm happens to patients, like death or permanent harm”.  She said the top errors were medication errors, wrong side surgery and delayed treatment. Although, it is unfortunate for any patient to have to deal with the effects of medical error.  Medication errors, wrong side surgery and delayed treatment have been issues long before EHRs were implemented. In order for this statistic to be significant it would be necessary to know how often these events were happening before EHR’s were implemented and after EHR’s were implemented. The statistic alone does not have much significance because the EHR could have just been a vector for an error that would have occurred anyways. EHR systems, HL7 messages or any type of non-custom integration typically do not have surgery side specified.

Richard Rothman, Founder of The Rothman Institute and James Edward Professor at Thomas Jefferson University then went on to discuss the positive and negatives of EHRs. He said that predictive modeling is helpful in determining risk factors such as HIV, diabetes or renal disease for major surgeries. He also discussed how EHRs can help lower medication errors by providing drug interaction flags for physicians. The negative aspects he discussed were the risk of losing the interaction of compassion and care because the provider has to be focused on entering items into the EHR and loss of privacy. Privacy is an issue because “ninety-seven percent of corporations are hacked today plus the NSA is hacked we all know that”.

Robert Robbins, President and Chief Executive Officer of Texas Medical Center said “we are not going to paper records, we are going to move forward and use electronic records, so we need to focus on how to make the EHRs better”. He thinks that voice recognition software could be efficacious in removing some the issues providers have with “customer service issues” due to EHRs taking the attention away from patients. He believes EHR’s “definitely improve quality”, despite some of the articles that cite miscalculations and unintended consequences due to EHRs. “It’s a place you can get all the x-rays, you don’t have to run around finding the chart or trying to decipher someone’s bad handwriting”.

Paul Black, President and Chief Executive Officer of Allscripts followed up discussing EHR workflows and how it is sometimes necessary to make them complex because there is certain data that is required from a quality reporting standpoint. He said there is “no substitute for the value that is garnered in the backend of all the data that you have as a result of clinical and financial automation”. However, he understood it is necessary to listen to providers when they say it is impeding their ability to perform medicine, for example if there are too many clicks in the workflow. Erin Dupree interjected that is “so hard to get the data out”, Mr. Black followed up with “it is also very difficult to abstract clinical paper charts”. He said there is certain data that the EHR needs to collect to be ONC certified and that the clinical practice needs to collect to be certified for Meaningful Use, but “they are trying to simplify the process everyday”. He said “we’ve spend the last 30 years automating healthcare and some people think we are done, but they’ve really missed the point. All healthcare is now digitized but it is incumbent on us to do something with it.” Mr. Black thinks interoperability is a key piece making use of data and exposes API’s on top of Allscripts software. He is also encouraging a platform for developers to make apps on top of the software. He said “the apps have to be plugged into something and the reason why the internet bubble blew up was because it didn’t attach to anything. It is now cool to say your open, we’ve been open for a really long time”

Jonathan Bush, Chief Executive Officer and Co-Founder was up next and animatedly talked about the irony of the fact that they were discussing whether or not it was a good idea to switch from paper records to electronic records when “everything in our lives is on the internet”. He said “This internet thing, I swear to you is going to be big. We have to skip software and go to the internet. We must connect care.” “Everywhere else software is not the thing, software is the store you go into to get the thing, nobody bought a copy of amazon. We digitally walk into Amazon to get stuff. We don’t need to keep paying money for software that in and of themselves are not connected to anything. He explained the EHR business model is inhibiting the healthcare industry from getting to connected care and interoperability.

EHRs are not perfect, nor should they be expected to be this early in the transformation from paper records to electronic records.  The software, training and implementation costs are expensive, however like the members of the panel said we cannot go back to paper records because that is expensive too.  There ARE risks associated with EHRs, but the rewards far outweigh the risks.  The process is sometimes messy as I know having worked on more implementations that I can count, but each implementation has “lessons learned” which makes the next one more seamless.

Below is a clip of Jonathan Bush speaking at the conference


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