Technology and innovation have a way of turning the future to the present and of altering the past so that it is difficult for us to imagine what our lives were like prior to a technology’s adoption.
Try it now.
Try to imagine what your life was like before the smart phone, the internet, the television. In the world of healthcare, try to remember what the care experience was like prior to the electronic health record (EHR).
For Ann O’Brien, clinical leadership veteran and recent recipient of the HIMSS Most Influential Women in Health IT Award, to remember life prior to the EHR, she has to remember all the way back to 1991.
On a recent STEPS to Value podcast episode, O’Brien described her time as a nurse educator and clinical project manager at the Davies Award-winning Lucile Packard Children’s Hospital at Stanford. The hospital decided that along with major physical renovation, they were also going to go paperless.
“Its seems kind of amazing now, 26 years later, but that was my experience, me as the nurse educator, having to take on that project to learn about EHRs and clinical documentation, and how to convert our very large flow sheets and paper physician orders into an electronic health record,” O’Brien stated with a laugh in her voice.
The Promise and the Unexpected Challenges
“Most healthcare plans, providers and large healthcare-managed care organizations, as well as hospital systems, are really trying to figure out what the best type of [patient] visit is so that the individual consumer, patient or family member feels like they are receiving the best care possible at that time. Whether it is at 11 o’clock in the morning or at 3 o’clock in the morning.”
But, O’Brien said, “the combination of EHRs, virtual care and the consumer having so much choice, has created benefits and additional burdens for all clinicians.” O’Brien described one of the unintended consequences of healthcare consumerism, the ability to communicate with our clinicians by email. Clinicians come home from seeing patients all day to “another two or three hours” clearing out the daily onslaught of email communication, all to keep pace with that day and not add more work to the next one.
When asked about the impact of big data on clinicians’ daily experiences, O’Brien spoke to how the current promise of big data doesn’t yet outweigh the frustrations that are born from too much data collection at the point of care. “Should we collect the data? If we know how to utilize it, mine it and organize it. Big data science right now is still in its infancy.
“So we have a lot of tools, but we don’t have all the sophisticated interoperability and opportunities to convert that data. If someone wants to send in all the information off of their smart watch every single day, the physician doesn’t need 5,000 blood pressures, what they need is to have intelligent tools to make sure that the data is being organized in a way that the information is actionable for the clinicians. We are not quite at the point where the physician, or the nurse practitioner, or the community health educator can have that data be organized in a way that is personalized, meaningful and actionable.”
Transforming Care While Reducing Clinical Burden
This past June, HIMSS and the Association of Medical Directors of Information Systems partnered on a letter to the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health Information Technology for public comment on addressing the issue of clinician burden. In the letter, the two organizations highlighted the opportunities to leverage people, processes and technologies now and in the future that focus on the quadruple aim of improved quality and experience of care for both the patient and provider at lower costs.
The letter outlined how addressing clinical burden can result from and contribute to a learning health system. The letter discussed the importance of building momentum toward team-based care by placing a greater emphasis on reporting from the full clinical team, and how proposed changes to quality reporting and promoting interoperability are steps toward lowered clinical burden. It also addressed the importance of repurposing data from other sources and simplifying evaluation and management coding as useful actions toward reducing clinical burden.
As national healthcare systems across the globe work to find that balance between impactful data collection and undue clinical administrative burden, O’Brien reflected back as she considered how health IT has impacted her life as a nursing and clinical informatics leader and how she has worked to impact health IT. “Over the last 25 years I have really worked on the implementation, the optimization and transformation of EHR data. We are starting to actually see the impact of true improvement in quality, safety, patient experience – and now the quadruple aim – of the clinician’s experience.”