By Edgar Chou, MD, MS, FACP

System improvements, quality, patient safety, people and data...these are what come to mind when I think about informatics. We are in a very exciting time in the field of medicine as it relates to the availability of information and application of technology toward the improvement in patient care. One of the daily challenges is what to do with it and how to do it so that it’s easily consumable and actionable.

I am dating myself, but I was first introduced to electronic health records back in 1995. As I happened to work for my father’s software company, this forward thinking group had developed a computerized system that they were hoping to market internationally. While I had no understanding whatsoever about medicine, it did seem to make sense at the time to use computers to document and store information knowing that there would be current and downstream uses that would not be possible on paper. This was during my between years -- between graduate school and medical school. During residency, we did have a computerized physician order entry, but documentation remained on paper. The VA actually already had an electronic system at that time and while documentation was rather straightforward, there was already built-in decision support to guide the clinician on preventative guidelines. This was in 2000. My path to informatics may be similar to others, where I had implemented a hospital wide paper-template system, in answer to the frustration with redundancies on physician attestations that had to be written as we oversaw resident trainees. We added items to aid physicians in reminding them of documentation (E&M) rules along with the attestation that began with “I have seen & examined the patient with …” This effort to improve processes was recognized, and I was asked to partake in our EHR implementation acting as the physician champion, which led to subsequent advancements in my career. This all transpired prior to the passage of the HITECH and what has been fondly known as Meaningful Use, where we continue to achieve the requirements with our EHR vendor and clinicians and staff.

Fast forward to 2019, where I have experienced the trials and tribulations of implementations, multiple upgrades, system crashes, vendor delivery challenges and over promises with under performances. Despite this, there have been slow but sure incremental improvements in how we deliver patient care. My greatest driver in this field is knowing that this work impacts all our clinicians and staff and the thousands of patients that are seen in our healthcare system daily. We need to ensure that information is shared in such a way that is beneficial and efficient to all users of these systems. By sharing our findings and challenges, others could also benefit in the care of their patients. Changes that are made in these systems may have broad implications, where understanding the government initiatives, payers and actual understanding of people and systems are essential, which highlights the importance of individuals working in this field.

Our organization has moved forward with developing a concentration for medical students to have a broader understanding and exposure to the field of clinical informatics. I am excited to be part of this initiative and educating future students in this relatively new subspecialty. While there are still many areas to improve in the day-to-day usage of these systems, no one can deny the benefits of having items in an electronic format. As technology improves, so will healthcare, which is now moving more in lockstep with these advancements.

The old adage of working smarter, not harder, should be the mantra of the electronic health record vendors as they provide solutions to the challenges faced in the healthcare space. I look forward to making continued contributions to my organization, for the physicians and staff who use these systems, and to broaden the appeal of this field to others.

About the Contributor

Edgar Chou, MD, MS, FACP currently serves as the Chief Value Officer of Drexel University College of Medicine. He also serves as the Chief Medical Informatics Officer, where his activities include oversight of all government regulatory programs, value based, quality and patient safety initiatives for the organization. Dr. Chou is also a current member of the HIMSS Physician Committee.