Do you remember going to the doctor’s office as a kid? I do. Between the shots, stickers, and “safety suckers” I remember my parents talking to the pediatrician while she furiously scribbled on pieces of paper. Fast forward 20 years and doctors are still furiously recording patient information, but the scribbling is replaced with clicks on a keyboard or swipes on an iPad as your doctor records your ailments and orders your medications directly through an electronic health record (EHR).
Meaningful use and the “digitalization of things” for the Health Care models.
With the adoption of the Affordable Care Act (ACA) in 2010, hospitals found themselves in a unique position. Among the new standards introduced was one of particular importance to the digitalization of Health Care—Meaningful use. Meaningful use standards were enacted to incentivize hospitals to switch from paper charting to an EHR. Designed to be implemented in 3 phases, Meaningful use meant “using certified EHR technology to:
- Improve quality, safety, efficiency, and reduce health disparities
- Engage patients and family
- Improve care coordination, and population and public health
- Maintain privacy and security of patient health information
Ultimately, it was hoped that compliance would result in:
- Better clinical outcomes
- Improved population health
- Increased transparency and efficiency
- Empowered individuals
- More robust research data on health systems
When the ACA was introduced, hospitals were functioning with two very distinct business models. Vanderbilt Medical Center in Nashville, TN, for example, needed to address two main issues for patients.
- “I need to know what the problem is, what is causing it and what I can do to correct it .”
- “Now that I know what needs to be done to fix my problem, I need it to be done effectively, affordably and conveniently .”
Operationally, being able to deliver on each of these models required medical institutions to function as two separate entities. The first, a “solution–shop,” necessitated a hospital have robust capabilities to diagnose and to develop treatment plans . The second, an ability to carry out said treatment plan with specific processes and procedures .
Harnessing the EHR for operational efficiency
American physicians record 126 million out-patient clinic visits and 313 million inpatients days annually [6,]. In today’s medical setting, the EHR plays an integral role in physicians’ day-to-day tasks. The modern doctor spends as much time (or more) reviewing patient charts, recording data, and entering medication orders as he or she does interfacing with patients. But why is this?
With the incorporation of the EHR, physicians now have a more robust mechanism to review patient charts. Take, for example, a patient transferred to Vanderbilt from an outside hospital for a severe asthma exacerbation. The first task for physicians, while the patient was in route, is to review previous notes, lab results, and medications—all included within the EHR (shown below). The EHR allows every physician in this patient’s care to review, simultaneously, real-time results. The critical care physician who manages the Intensive Care Unit, the pulmonologist seeing the patient upon arrival, and the Ear Nose and Throat doctor who may be consulted, can each see the patient’s most up-to-date information, and formulate their treatment initial plans based on data. Physicians can see what treatments have worked before and those that had not. This more robust EHR system merges hospitals’ business and operating models into parallel processes and combines all the patient data into a “searchable” database.
Does it actually work?
With the final phase of Meaningful use to be implemented in 2016, it is a good opportunity to stop and check if the digitalization of Health Care, particularly the incorporation of the EHR, has truly resulted in improvements. The Office of the National Coordinator for Health IT reports that 3x as many physicians believe an EHR prevented a potential medication error rather than caused one and greater than half of all physicians using EHRs were reminded to provide preventive care by their EHRs [3,5,8,9].
This picture, though, is not as rose colored as it seems as these same physicians reported longer working days, more time spent charting, and increased frustrations with the deluge of information presented to them through EHR platforms.
Fixing it going forward
Going forward, physicians will be faced with an ever-increasing onslaught of data and hospitals will have to find ways to cope with these new challenges introduced by the EHR. Potential solutions include the utilization of one standardized EHR platform throughout the country, as well as the leveraging of advanced computing technologies (like IBM’s Watson) to cull through and to make better use of unstructured medical data.
Overall, the digitalization of hospitals is an inevitability. The question, though, is how do we enable health care providers and patients to truly use the data they generate. (795 words)
 National Hospital Ambulatory Medical Care Survey: 2011 Outpatient Department Summary Tables
 Summary Health Statistics: National Health Interview Survey, 2014
 The office of the National Coordinator for Health Information Technologies
 The office of the National Coordinator for Health Information Technologies: Physician-Reported Safety and Quality Impacts of Electronic Health Record Use
 Vanderbilt University Medical EHR