I chair the HealthIMPACT series of events that is held in a variety of cities throughout the year. HealthIMPACT is a no-nonsense and “No BS” local one-day event for busy health IT professionals that pretty much know what they’re doing but are looking to learn from their peers (instead of professional presenters). We don’t try to add further hype to common trends everyone’s already seen many times or explain the obvious to make ourselves look smart; we explain the implications of trends to your daily work, figure out how to operationalize innovations, and provide actionable advice so that you can do your job better. We recently concluded our third successful Forum of the year in Houston, TX. Our next event is going to be held in Santa Monica, CA on June 10th and there are still a few seats available. We have a “no PowerPoint” rule and all the sessions at HealthIMPACT are conversational and interactive but one of the most interactive sessions in Houston was one I moderated with Samir Badlani, Chief Health Information Officer at Intermountain Healthcare, Arun Matthews, Chief Medical Information Officer at Medical Center Hospital and Sean Benson, Vice President Innovation at Wolters Kluwer Health. Samir, Arun, and Sean shared their thoughts on the creation of new patient care systems and improving design of dashboards to improve diagnosis and treatment at the point-of-care (while leveraging existing clinical support tools and advanced informatics). My friend Raju Chauhan, a healthcare data modeling and architecure expert, was in the audience and was kind enough to give us his take of how it went. Here’s what Raju reported as the recap of the panel’s discussion:
The panel agreed that EHRs started as a financials tracking systems and have now grown into patient record keeping repositories with a whole lot of patient health information. EHRs have now become clinical transaction systems and can provide a wealth of information but question is whether the captured information is actionable or not. For example systems developed at University of Chicago can predict that a patient will have Myocardial Infraction in 31 hours but there is nothing that a doctor can do to avoid it. Is this insight actionable and useful? Systems are also able to help health systems decide whether to utilize latest technology or an older cheaper technology for Tonsillectomy based on the outcomes to make a purchase decision. Incidentally in this case it was found that older, cheaper blades used for the procedure vs. newer technology had no significant outcome improvement but had a cost difference of 10000% ($0.06 vs $600). This insight make the decision making process simple and useful.
Modern patient care systems collect a whole lot of patient information but the question is “How do you get clinicians excited about data collected through various channels and analytical insights from such data”? Here’s what Samir, Arun, and Sean thought:
- First and foremost transparency is a must, be prepared to share details and processes by which data is synthesized
- Include multiple physicians in the design process and to solve issues. It is not sufficient to base a system design by simply including a single physician / clinician on the team, multiple experts should be consulted.
- Design systems to solve specific problems and demonstrate specific improvements
- Educate patients on how the analytics and data helps refine processes and improve patient care
- Be cognizant of alert fatigue and attempt to reduce alert fatigue, avoid false positives to manage the interruptions induced in a clinical workflow. Alerts should be based on a simple principle of (clinician) “Did not know and wants to know”
- It is important to keep physician / clinician workload in mind when proposing and designing new systems. The new systems should:
- be disruptive to benefit but do not disrupt clinician’s workflow
- help automate clinician’s workflow
- automatically capture useful information as the clinician engages in patient care, e.g., moving in and out of examination / hospital room; remote transcribing of voice notes captured in exam rooms.
- help automate the associated business processes, e.g., capture progress notes electronically as clinician dictates
- determine what work can be offloaded off the doctors to other licensed and qualified resources like Nurses and Pharmacists
- Include patients as part of the solution as well as demonstrate a benefit to patient care by leverage analytics to share with the patients, for example, present relevant knowledge and educate the patient
- Include data from devices directly into the patient records by using device interoperability so that it can be factored in by the clinicians for patient care easily. Today such data may be available but not integrated. Doctors may be reading such devices and duplicating such information in EHRs which can be error prone.
It was also interesting that Sean, Arun, and Samir all agreed that dashboards shouldn’t be the target. Instead, it is important to improve the information that present patient information to a doctor for diagnosis and treatment at the point of care. They suggested many things to consider in effective dashboard design:
- It is important to validate the visual presentation of data with the clinicians
- Include analytical groups to guide the design and development and presentation of insights
- Provide next possible actions to take – Today dashboards are designed as scorecards and focused on where the clinician may be lacking, instead it would help if the dashboard can show leading actionable measures. As an example it would be helpful to know when a patient needs his next antibiotic dose as well as how many are waiting for their next dose so that a nurse can plan out the work. An actionable leading analytics would help improve patient care.
- Present all relevant data on single screen to the doctors based on the context of the work they’re doing
This was a great panel. Obviously, meaningful use initiative has overwhelmed physicians with additional tasks in their day-to-day activities and it is important to help doctors with compliance so that they can keep their focus on patient care.
Our next HealthiMPACT event is going to be held in Santa Monica, CA on June 10th and there are still a few seats available. Register today!