Time to declutter your electronic health record
By Dr Turner Billingsley, Chief Medical Officer, InterSystems
Although my current practice is no longer direct clinical care – I work for a healthcare-related technology company – I remember what it’s like to wear a practicing clinician’s shoes. I know that getting the right information to clinicians when and where they need it has the potential to save lives.
While it’s true that we’ve gone from incomplete paper records to electronic health records (EHRs), one problem that has resulted is too much irrelevant information. Many EHRs have too much clutter, and clinicians don’t have time to pull out the relevant information.Working with very capable partners, we are creating a variety of solutions that help to put information from the EHR into a clinically relevant context.
The ability of these solutions to focus on information relevant to clinicians could prove very useful in New Zealand with all the work that is going on to be able to share EHRs more easily within organisations and beyond.
One example is by creating consolidated views of clinical data across disparate sources, available in the clinician’s workflow, in the “native” EHR. Leveraging our partner’s ontology capabilities, the “clinigraphic” puts disease-specific information in a single,concise graphical view.
For example, a doctor could select the clinigraphic for congestive heart failure and see graphical representations of the patient’s weight, BNP, and ejection fraction, along with relevant medications and comorbid disease conditions. The data is drawn from many sources and includes discrete information that is extracted from free-text documents, such as radiology reports.
Alerts are another way to draw a clinician’s attention to relevant information. One of our information exchange clients,which is the largest health information exchange (HIE) in the United States, is using predictive risk models that leverage machine learning analytics from another one of our partners to calculate a patient’s risk for issues like inpatient admission, emergency visits and the development of diabetes.
This application considers the local population and can send specific risk information directly to the patient’s record, allowing clinicians to see high-risk areas that are highlighted in red at the time of a visit. Through this capability, population health can be impacted at the moment it matters most.
That same HIE also sends about half a million clinical event notifications every month. As one example, a primary care doctor receives an alert when a patient visits the emergency department or has an acute hospital admission. The HIE reports that the alerts are particularly useful for patients with complex conditions. For example, after receiving an alert, a primary care doctor could contact the emergency department while the patient is there to offer additional insight.
Clinical inferences are another way technology can help clinicians at the point of care, in this case by inferring from data in the record that the patient has an undiagnosed or undocumented condition. For example, say a patient has reported leg swelling to one doctor,shortness of breath to a resident at an outpatient clinic a week later and recently was noted in an echocardiogram to have decreased cardiac ejection output (low ejection fraction). The clinical inference engine can suggest to the clinician that a diagnosis of congestive heart failure may be in order.
If you ask doctors what information they need on their patients, they will say, “I need it all”. But when that information is delivered without organisation, relevance, context and added value (“knowledge”), it can quickly become overwhelming. What clinicians need is quick access to relevant information at the point of care, and these next generation applications represent exciting new ways to deliver exactly that.
About the Author
Dr Turner Billingsley brings a unique combination of medical and technology expertise as well as thought leadership to the position of Chief Medical Officer (CMO) at InterSystems. In this role, he works with healthcare customers, assisting with ongoing development of healthcare technology offerings, and representing InterSystems in the healthcare IT sector.