We have all this data, but what do we do with it?
Interoperability is, and has been, a buzzword since EHRs became more common in clinical settings. Interoperability is important for providing the best care not only for individuals, but it also has the potential to provide unique insights and predictive analytics to help make better decisions for population health. Steps have been taken to improve interoperability, particularly between different EHR vendors, but there is still work to be done.
One thing that is often missing from the conversation is now that clinicians are able to access all this data, what should they do with it? I’m sure that people are thinking the answer is obvious: use it to make better clinical decisions. But it’s not that easy.
Submitted work by Drs. Steinkamp, Kantrowitz, and Airan-Javia on patient notes at Penn Medicine found that average patient charts have around 4,000 words. For context, this is about 1/6 the length of Shakespeare’s longest work, Hamlet, which is just under 30,000 words.
The Physician Foundation’s 2018 Survey of America’s Physicians found that on average, physicians see over 20 patients per day. Imagine reading Hamlet two to three times a day. How would clinicians find the time to do that, on top of all the other patient care and administrative work, and still having time for their lives outside of work? It is not feasible.
How do charts get like this?
Note bloat, excessively long notes filled with redundant and nonessential information, contributes to this data overload. Often, note bloat comes from copying and pasting information from previous notes, even if the information isn’t relevant to the current encounter. In a typical note, 46% is copied from a previous note. And note bloat has gotten worse recently. A JAMA study of outpatient specialties at an academic medical center found that from 2009 to 2018, the median note length increased 60.1%, from 401 words a note in 2009 to 642 words in 2018.
So why do physicians copy and paste so many notes? One of the most common reasons is to protect themselves from risk and liability regarding regulatory requirements. A 2017 AHA report found that health systems, hospitals, and PAC providers have 629 discrete regulatory requirements they must comply with. U.S. physicians’ notes are four times as long as physicians’ notes in other countries, likely due to these regulations.
Time constraints also contribute to note bloat. A study of family medicine physicians found that physicians spend over 2.5 hours a day on documentation and administrative tasks. They are rushed for time and are concerned about meeting all the documentation requirements, so they copy and paste notes to quickly meet the regulations. Unfortunately, this means that crucial information sometimes gets buried in old notes, and clinicians don’t have time to find it, meaning the information gets missed when creating care plans.
In addition to note bloat, other technology and data sources contribute to the data overload. Population health platforms create valuable insights that have the potential to vastly improve health. But if this data is outside the EHR, is not easy to access, and does not provide specific ways to act on these insights, then how often do clinicians actually use the data? Having important information that could greatly improve health outcomes just sitting there is a wasted opportunity.
How can we make data more usable?
How can we make this data more usable? One strategy is to improve documentation by taking out redundant and unnecessary information. Offering note templates – and training on how to use these templates – can help clinicians quickly write new notes for each encounter and reduce extraneous information added through copying and pasting previous notes.
Another strategy is using tech to make it faster and easier to view data. Instead of delving through pages and pages of notes to see how a patient has been managing their diabetes, wouldn’t it be better to take two clicks and find a graph of their blood sugar over the last few years? Intuitive data visualization can take data and make it easy to see trends over time, providing clinicians with an overview of the patient’s history regarding a specific health issue and allowing the provider to make quick decisions.
For population health platforms, integrated platforms built for care orchestration can help make the insights actionable. Once the population health platform provides insights, care orchestration technology can use these insights to create specific tasks for a patient. When the tasks are explicit and quickly accessible, clinicians can easily incorporate these tasks into their workflow and patient encounters.
Having more complete information for individual patients – and for populations as a whole – is a great step towards improving health. But now it’s time to take the next step and use this data to the fullest extent.