Given the demands we place on technology today, the idea of using a smartphone from a decade ago seems laughable. But that’s akin to what medical professionals must do when using legacy EHR workflows alongside an increased demand for information.
As a clinician who has worked in the EHR space since residency, Steven Rube, MD, FAMIA, is well-versed in its role in modern medicine. We sat down with him to chat about EHR workflows – including why it’s so important to bring back the ability to tell a patient’s story while using an electronic chart.
IMO: What are some of the challenges faced when developing EHR workflows?
SR: Creating EHR workflows clinicians want to use is tough because of some of the nuances involved in the practice of medicine. [The patient-physician encounter] is a very intimate encounter. A patient comes to the doctor with something they probably wouldn’t speak about with others, and let’s be serious – a medical exam is not fun for most people. Therefore, the interaction has to be approached and managed carefully. It cannot be one involving a patient looking at my back while I try to be a data entry person. Plus, physicians tend not to be the best at data entry. We probably never will be. Instead of asking how we can improve that skill, we need to be looking at the problem differently and asking different questions.
IMO: What’s missing in today’s EHR workflows?
SR: The medical record must have the ability to tell a story. In the paper world, we were able to write that story out clearly, but often not legibly. I knew what I was saying, and I was able to communicate that to my colleagues. One of the things you may now hear physicians say is that the EHR has limited their ability to tell the patient’s story. Clinicians will understand what that means – you end up abstracting patient stories to a common denominator. Now, all chest pains sound the same, all abdominal pains sound the same. We’re losing many of the nuances that are part of the art of medicine. This is a large aspect of what changed when we went to electronic from paper.
IMO: What do we need in order to bring back that storytelling, that nuance?
SR: My stethoscope is something that I can’t do without because there’s nothing better that will allow me to accurately and efficiently listen to your heart. We need to ask why the EHR has not become such a tool, and what we need to do to make it indispensable. Advances like natural language processing engines are finally getting to the point where they can be useful. Machine learning and artificial intelligence are too. But we need to ask can they understand me…can they understand the patient…before they become tools in my arsenal.
IMO: How can we improve EHR workflows?
SR: Listen to the people who use it and live in these EHR workflows daily. That will help us more clearly understand the problem. Solutions that may seem obvious are often off-target when presented to an end user, and there’s not necessarily one right way of doing things. Primary care physicians may practice differently than specialists. Medical physicians may practice differently than surgeons. We really have to delve into the nuts and bolts of EHR workflows to understand what these people are trying to do before we can make improvements.
IMO: What are some other considerations people might not think of, but are important?
SR: Well, I think it’s important to recognize that patients are much more clinically and technologically informed today. They expect more detailed information and that their records will be available to them. So, we not only have to take into account the EHR workflows of the physicians or the hospitals, but also consider the patient’s needs and expectations as well. Their appetite for their own clinical information is growing exponentially.
