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By Mukul Mehra MD
As a physician and co-founder of a health technology company that supplies relevant information to doctors at the point of care, I respect the challenge of having to constantly weigh the value of that data in relation to its impact on the clinical pathway. I understand firsthand the real value of an engaged physician keeping a patient the main focus during an appointment. I can also appreciate the power of using data to make an informed decision or treatment recommendation in real-time. In healthcare, we struggle as an industry to balance this dynamic, but I fear that meaningful personal interactions are being forfeited in favor of access to ever greater volumes of health data, and both physicians and patients are feeling the strain.
One of the most vexing tasks for a clinician is taking an amorphous patient presentation and giving it structure. For example, I once saw a patient who had Parkinson’s, weight loss, a history of kidney stones, pain on the left side, and constipation. Her chief complaint was, “I just don’t feel good.” That’s a very unstructured scenario with disparate symptoms and issues to work through. I’m not sure how AI would even begin to structure such a visit. The very first step is to hold this patient’s hand and sit at her side, bringing her comfort as a human. As the first doctor to see her, I had to determine that she’s constipated because of a new medicine, but the significant weight loss is due to the fact that she’s depressed. But how do you structure the presentation in getting to that analysis? What database or decision support would a computer program access to diagnose five different symptoms that can be interrelated in any number of ways? “Weight loss and constipation equals colon cancer doesn’t it?”
I believe that the art of medicine today, and for the foreseeable future, still lies in a clinician’s ability to extract all of that unstructured data from the patient and sift through the noise to bring it down to something clean and meaningful that benefits the patient. But that requires focus and time, both of which are dwindling thanks to current trends in healthcare. We need to find a better way to document the facts and findings of the physician-patient interaction without disrupting it. We are about to enter an era of data deluge including peripheral device data entering the record. It’s data that is often irrelevant, so who is responsible for this data “dump”? What if I don’t need or want it?
I sense many physicians I meet feel the EMR has taken us away from what we natively want to do, which is ask patients questions in an interview-style format and then work off of those questions and answers to generate other investigative questions. It’s this simple bidirectional interaction that leads physicians to the next thought of what could be going on and how to treat it. It’s like solving a crime. The patient’s medical history, physical exam, and diagnostic test results are tools that may lead to important clues. They can save unnecessary tests too as in my example above. Checking boxes in the EMR, figuring out ICD-10 codes, and spending time typing in the right fields of a template make highly qualified clinicians simple data entry specialists.
What’s happening in the workflow now is that you’re opening the EMR screen, and an alert pops up before you’re even allowed to start the process of listening to your patient’s chief complaint. This leads to a human physician-patient interaction that is now replaced with a physician-machine-patient interaction model that has far less value to both the physician and the patient. The unfortunate reality is that physicians are forced to work around how an EMR is built rather than the EMR being built around a physician’s natural thought and treatment processes. We’re seeing a high rate of burnout among physicians due in large part to all the disruptive, sometimes even worthless, data and alerts taking up precious real estate on the EMR screen. It derails clinicians because the process of documenting the interaction with a patient supersedes, and in many cases, overshadows the interaction itself.
Research shows that the EMR adds an hour and half to two hours a day to the physician’s workload. Add to that the seemingly endless list of health IT companies integrating with the system to provide insights, not realizing where a physician is in the thought process of that patient’s treatment.
We are clearly not going to reverse course with regards to the use of technology or electronic health record systems in healthcare settings. Health systems have invested billions of dollars in these systems. So, the real challenge is to present valuable data, essential data, on top of the EMR screen at the right time and reduce documentation burden.
At IllumiCare, we spend more time trying to figure out how not to annoy or distract physicians, which led to the development of the Smart Ribbon: A small, unobtrusive ribbon of data that hovers over the EMR. When physicians choose to interact with the Smart Ribbon, three events are triggered: user context is harbored, only the most actionable data is presented, and the user can decide to further engage the information or not. It’s a much friendlier way of presenting data contextually at the point of care.
Positive feedback from physicians who interact with the Smart Ribbon on a regular basis has proven that this design approach empowers users to make more informed decisions in a less disruptive fashion.
An example of an application we built would be WHIRL, a Smart Ribbon app that integrates with Epic to gather key patient data from the EMR and transcribes clinical summaries to a piece of paper with just one click. The app allows users to customize columns displaying records such as vital signs with ranges, lab values with priors, imaging or procedure results, flowsheet values, shorthand nomenclature, and greyscale.
Over the years, I’ve balanced a dual career as a gastroenterologist and health tech entrepreneur, realizing that neither the patient nor physician benefits from the dehumanization of medicine. To that end, let’s adjudicate if additional data is valuable, then figure out how to present it, and to whom. It’s a lesson that I think is worth remembering and putting into practice for every health IT solution. If we don’t rise to meet this challenge, then we will continue to lose great clinicians, which is something that should seriously concern us all.
Mukul Mehra, MD, is the CMO and co-founder of IllumiCare and was a practicing gastroenterologist for nearly 20 years. Dr. Mehra designed the Smart Ribbon, now used in more than 250 healthcare facilities nationwide, to assist in, not impede, smarter fiscal and medical decision-making where physicians can control cost. Dr. Mehra received a MD from the University of Alabama and completed his residency and fellowship at Washington University School of Medicine in St. Louis.