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Is That My 400-page Paper Chart or Are You Just Happy to See Me?

by Derek Hedges, Senior VP of Business Development

In my entry last week, I said that I’d review some additional examples of technology playing a key role in easing my experience as a patient battling Stage 4 colon cancer. I am going to loop back to that train of thought later and instead discuss one of the shortcomings of technology that I experienced just prior to two of my four surgeries.

Have you ever read The Wall Street Journal (WSJ) or The New York Times (NYT) on an iPad? It’s a lovely experience. The iPad is completely intuitive in a way that allows a reader to easily cover a myriad of information. Within seconds, I can go from the front page to the opinion section to the market news. Then, I can see unrelated articles within those sections. It’s ingenious, easy and fun to use.

So, let’s compare that experience to searching the massive quantity of information that is collected in an EMR for a patient like me. You’ve got basic family history, presenting illness, medication lists, op notes, infusion notes, visit notes, scans and reads from radiologists, EKGs, etc. Basically, like the WSJ or NYT on an iPad, a medical record holds a lot of disparate information that is tangentially related. Clinicians want quick and easy access to the data that they deem relevant—they don’t want to lick their fingers and turn pages to find this information.

So, let me talk about my first pre-op visit. I’ve had four surgeries since my diagnosis and all have had the exact same pre-op process unfold. I meet with my anesthesiologist or a stand-in, as well as several nurses and physicians, to talk about prep for the operation and what’s expected afterward. They draw some blood and give me an EKG test.  Standard stuff, I think. 

Well, about 30 minutes into my first pre-op meeting, I almost started to cry. 

That’s because each person I met with during this three-hour pilgrimage was lugging around their own copy of my 400-page chart. HERESY, I thought! An institution that has utilized technology quite well, thus far, was clearly in the neonatal phase of life as it related to sharing (or viewing) vast quantities of information across a wide group of people. 

The computer/EMR just didn’t cut it, obviously. I asked several doctors if the paper medical chart was standard for this part of the care process and the answer was “yes.”  It must be viewed as the quickest way to access random pieces of information buried in various portions of the patient’s vast chart. The format of the EMR must have limitations in this regard – likely designed for quick data input, with little regard given to the consumer who needs a specific view of a patient’s information further down the line.

This scenario was illustrated quite starkly to me. As a patient this time around, I could see the dichotomy between an EMR as a “piece of software” to input and store data, and this institution’s particular EMR as a “piece of software” to share discrete data across a broad group of stakeholders. It’s clear that, in some cases, an EMR can accommodate quick data entry. It’s also clear that an EMR can be useful as a data-sharing tool—when you know what information you need (e.g. when viewing a specific scan or blood tests). 

Having said that, based on the fact I was going through my pre-op process watching physicians thumb through my paper chart for awkwardly long periods of time, it was evident that the EMR does not offer a simple way to organize and render relevant information in all cases

Therein lies a massive shortcoming. And it’s affecting the simplified coordination and sharing of relevant clinical information at the time when the clinician needs it most—while standing in front of the patient.  This is where technology can be incredibly useful in determining what information is relevant based on the physician’s guidance. The utility comes from being able to present it in a manner that enables the clinician to quickly digest important information. The comparison to accessing The Wall Street Journal on an iPad quickly comes to mind because their sections, “article titles and summary” and “complete article text” can be accessed with a few finger swipes.

See the comparison for how relevant medical data could be organized for quick and predictable access? 

Although some companies and institutions claim to be making strides in this direction, it is certainly not easy. Done right, it requires the institution to gain access to all relevant components of a patient’s medical history, create algorithms to determine the relevancy of the information for a specific patient case and provide a streamlined ability to serve that relevant information reliably and quickly for consumption at the right time. 

As the amount of discrete data that is populated into an EMR extends beyond the limits of a human’s ability to find… search through anomalies… and digest, it is clear that information technology needs to take on that array of data, regardless of the complexity, and make it easy to access and digest. 

In so doing, the lengthy process of wading through a 400-page chart, as in my case, can be avoided. Relevant information can be teed up for the physician and the chance of overlooking a key data point can be drastically reduced. 

So here’s a question for you to contemplate: As you consider information technology solutions, how do you rate "ease of data entry" and "simplified & relevant data access"? What has your experience been, from either side of the exam?

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