Is the EHR a provider?

A chief medical officer at a large academic healthcare institution recently suggested that we reframe our thinking about the electronic health record (EHR). They said, “The EHR is more than a tool. It independently guides and directs care. As we look to the future, EHRs will increasingly determine patient care without supervision.”

Is the EHR our highest paid employee? This is a provocative thought. Over 98% of all hospitals and 97% of critical access and small rural hospitals in the United States have demonstrated meaningful use of certified health information technology.¹ Recent years have seen big jumps in adoption by general practitioners as well as psychiatric and long-term care facilities. While the EHR does not actually deliver care, it is clearly a critical component of the care team.

We can each opine on the role of the EHR and the future of AI, big data, personalized medicine, and other technology. If we think of technology like the EHR as a member of our care team, how might we use it – and support it – differently?

Care teams help us and heal us by working together. As a team member, the EHR should participate and contribute. Here are a few hallmarks of a successful team:

• Diversity – Team members offer individual skill sets and perspectives. A computer excels in facts, recall, and calculation, so the EHR can chime in with “I remember something you may not,” or “I see a pattern here,” or “Is the patient at risk of…?” Clinical decision support and surveillance are key to increasing the quality and reliability of the care we give.²
• Context – The EHR can be the voice of team members who are not present in the conversation. “This is an opportunity to reduce waste,” or “How will this impact the patient’s ability to continue her regimen. Or pay?” Whether presented as alerts or actions, when the EHR prompts downstream impacts, providers can make better decisions with broader context.³
• Focus – An effective team understands and aligns to organizational goals, it practices culture, and it navigates priority and complexity. Acknowledging the volume of strategic initiatives at the average U.S. healthcare system, most of us wrestle governance every day. Balancing the demands of growth and improvement with the need for stability and security is not easy. A team member cannot do everything and certainly not all at once.
• Pleasant – It is just more fun when we like our colleagues. Is the EHR easy to work with (usability)? Is it too loud (alert fatigue)? Is it hard to get anything done (efficiency)? Like a garden, our technology should be both intentionally planted and well-tended if we want it to produce.

What is the point of reframing our perspective on the EHR? Shifting our focus to experience rather than feature or function helps us determine whether the technology – or team member – is meeting expectations. That experience includes not only using the EHR but also getting help when needed. 

The support program you institute around your technology matters.⁴ A complete strategy includes infrastructure that supports the people providing and receiving care. Help must come in different forms, via various media, and at the appropriate time.

• A surgeon transferring a patient post-op to the ICU in the middle of the night needs to reconcile orders to continue timely treatment. Getting stuck ordering or transferring level of care can put patient safety at risk. A clinical help desk can guide workflow or workaround.
• An affiliate physician and infrequent flyer may work in your hospital once a month. They may use multiple EHRs at various organizations each week and need guidance reorienting to yours. Scheduled time to confirm system and patient access or availability via chat can ensure help is there if it is needed.
• A patient may be anxiously awaiting a doctor’s response or important results via their patient portal. Their ability to log in and find what they are looking for impacts their experience as your patient. Patient portal support can reduce stress at critical moments in care and recovery.

Today’s health systems rely on people, process, and tools to deliver care in our communities. Technology is increasingly designed to interact with us in the moment, focused on the task at hand. It does and will play a more active role in patient care. Progress is stepwise but thinking about our EHRs as a member of the care team could help us improve how we design our tools and whether we like working with them. A support program with this perspective may offer both a better tool tomorrow and a faster path to the future.

Supporting our staff is paramount. Provider burnout is directly correlated to putting patient safety at risk⁵ and directly influenced by the experience and impact of technology. Studies continue to identify significant EHR-related contributors such as time spent in the EHR, documentation requirements, perceived usefulness, and more.⁶

Thinking about the EHR as a team member instead of just a piece of technology allows us to assess its impact on the rest of the team and patients today, setting the stage for when it is better at augmenting human performance tomorrow.

1 https://www.healthit.gov/data/quickstats/hospitals-participating-cms-ehr-incentive-programs

2 Murphy EV. Clinical decision support: effectiveness in improving quality processes and clinical outcomes and factors that may influence success. Yale J Biol Med. 2014;87(2):187-197. Published 2014 Jun 6.

3 Khorasani, R., Hentel, K., Darer, J., Langlotz, C., Ip, I. K., Manaker, S., Cardella, J., Min, R., & Seltzer, S. (2014). Ten commandments for effective clinical decision support for imaging: enabling evidence-based practice to improve quality and reduce waste. American Journal of Roentgenology (1976), 203(5), 945–951. https://doi.org/10.2214/AJR.14.13134

4 MACE S. Expanding Help Desk Services. HealthLeaders Magazine. 2013;16(3):38-40. Accessed September 29, 2021. https://search-ebscohost-com.ezp-prod1.hul.harvard.edu/login.aspx?direct=true&db=heh&AN=86861902&site=ehost-live&scope=site

5 Garcia CL, Abreu LC, Ramos JLS, et al. Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis. Medicina (Kaunas). 2019;55(9):553. Published 2019 Aug 30. doi:10.3390/medicina55090553

6 Tajirian T, Stergiopoulos V, Strudwick G, Sequeira L, Sanches M, Kemp J, Ramamoorthi K, Zhang T, Jankowicz D. The Influence of Electronic Health Record Use on Physician Burnout: Cross-Sectional Survey. J Med Internet Res 2020;22(7):e19274. https://www.jmir.org/2020/7/e19274. DOI: 10.2196/1927