Few innovations in modern medicine are simultaneously as celebrated and maligned as electronic health records (EHRs). Progressing far beyond the premise of a paper chart—simply documenting a patient’s symptoms, diagnoses, and clinical care plans—they have grown into a vital tool in delivering care. They are a platform for ordering tests and prescriptions, for processing billing to insurers, for coordinating care across inpatient and ambulatory settings, and even for preventing errors.
But at the same time, when it comes to using this vital tool, it’s clear that EHRs have some problems. For physicians and other clinicians to keep an electronic health record populated with all the essential information, and for physicians to find the most important information to make decisions about a patient’s care, one side effect is what some describe as “death by a thousand clicks.”
Some providers worry about a general decline of humanism in medicine: schedules are busier, workdays are longer and they may spend less time looking patients in the eye and more with eyes on the screen. “There is an increasing sense that current day EHRs play a significant role in contributing to provider burnout,” said C. William Hanson III, MD’83, GME’89, chief medical information officer at Penn Medicine. “It’s time to turn our attention from deployment to refinement, to help doctors provide better care to our patients.”
In that context of balancing promise, practicality, and pain, Penn Medicine has launched an ambitious new plan to transform EHRs—turning them into more streamlined, interactive, smarter tools that ease the work of clinicians, expedite care, and drive the best possible patient outcomes.
“Increasingly, health information technology plays a foundational role in each domain of our work: patient care, educating the next generation of physicians and scientists, and biomedical research,” said J. Larry Jameson, MD, PhD, executive vice president of the University for the Health System and dean of the Perelman School of Medicine. “Electronic health records innovations are key to advancing our impact in each of those missions.”
Penn Medicine experts have already begun to map new approaches to EHR design. In a recent Perspective piece published in the New England Journal of Medicine, David A. Asch, MD, MBA’89, GME’87, executive director of the Penn Medicine Center for Health Care Innovation, and his colleagues suggested that a restructuring of the EHRs should allow doctors to “subscribe” to their patients’ clinical information to receive real-time updates when an action is required, similar to social media feeds and notifications.
The Penn Medicine Nudge Unit within the innovation center has developed approaches to ensure that patients are referred for lifesaving cardiac rehabilitation following heart attacks, that statins are prescribed to those who need their cholesterol managed, and advanced CT scan imaging is provided to all patients who need it, but not to those who don’t. Each of these care improvements was facilitated through a redesign of Penn’s electronic record system to serve physicians’ needs as they care for patients. And Penn Medicine data scientists and clinicians working in teams across the health system are developing other innovations that also may be built into the EHR in the future after being piloted in clinical settings; an example is “Palliative Connect,” which empowers palliative care specialists to proactively reach out to front-line physicians caring for seriously ill patients who would be likely to benefit from a palliative care consultation, as identified by a predictive algorithm.
“Ultimately, we need to move past the idea that the EHR is just an administrative tool, and see it as a clinical tool—like a scalpel, or a medication, or an X-ray machine,” Asch said. “We judge these tools by the degree to which they facilitate good patient care, and we should be judging the EHR against the very same standard.”
Penn Medicine is asking everyone involved with EHRs to step forward and develop their innovative ideas. This fall, a new innovation tournament launched to identify the earliest targets for EHR transformation. Teams from across the health system including IT experts, data scientists, and clinical educators will work alongside clinicians and staff to help develop, test, and refine improvements. The health system will also be introducing “sprints” in which clinical groups can work together with the different teams to streamline and improve EHR interactions and engagement with email and other digital media.
“Every day, we’re supporting, learning and running tests to investigate new ideas in the clinic, lab, and the classroom. Our best ideas come from within our walls,” said Ralph W. Muller, CEO of the University of Pennsylvania Health System. “With this initiative, the future of electronic medical records will be written by those working each day at Penn Medicine.”