By Joe Condurso, President and Chief Executive Officer at PatientSafe Solutions, Inc.
Twitter: @PatientSafeSoln
The billions of dollars spent over the last four years on electronic health records (EHRs) have helped many healthcare organizations achieve Meaningful Use, but many would argue they have not improved operational efficiency, clinical quality or safety to the levels leaders expected. The reason for this is EHRs are primarily designed for physician order entry to facilitate accurate billing and not necessarily to support clinicians at the point of care, with high frequency, short duration tasks and decision making at the bedside. These clinicians, who are downstream of the physician order, need mobile tools capable of delivering contextual clinical data and communications to more safely and effectively care for patients at the point-of-care.
With Meaningful Use Stage 2 front-and-center and Meaningful Use Stage 3 attestation on the horizon in 2017, organizations are finally beginning to realize the “post-EHR era” will soon be upon us. The emphasis will not be on government incentive programs, but rather actual goal-directed work done collaboratively and seamlessly between providers and the patient across a variety of care settings. As HHS Secretary Sylvia Mathews Burwell shared recently, the goal is to “create a better, smarter, and healthier delivery system.”
Achieving successes in quality care, however, does not require healthcare organizations to wait until the Meaningful Use program has concluded. Equipping frontline clinicians with a mobile overlay to the EHR that allows them to access clinical data in context, securely communicate with the trans-disciplinary care team and capture richer data at the point-of-care, for clinical rounding and clinical interventions. This type of platform to build on ensures best practices are followed and variability of care is reduced, both of which will be financially rewarded under value-based payment models.
Process over technology
While the first two stages of the Meaningful Use program are focused on implementing EHR technology, the proposed rules for Stage 3 fortunately transition that focus to care processes. For example, a proposed Stage 3 core objective requires hospitals to demonstrate use of clinical decision support tools in at least four of the six National Quality Strategy priorities, whereas Stage 2 only requires implementing clinical decision support technology. For the post-EHR era, clinical decision support is only the minimum of tools and information that frontline clinicians could take advantage of with the modern smartphone technology available today.
Consider the typical total-knee or -hip replacement procedure and how data accessed and shared by clinicians and patients through mobile technology can better orchestrate that care within the hospital and after discharge. Prior to the patient arriving at the hospital for the procedure, she would have already received and viewed recommended instructional videos and updated her medication list through her personal device. The most recent lab results, including decision support alerts, would also be accessible to clinicians and the patient through their mobile devices.
After the procedure, the patient’s insulin levels, which must be carefully monitored after invasive surgery, would be accessible to nurses and the surgeon in real-time through their mobile application. The ability to also prompt providers to check levels during pre-determined, evidence-based intervals is crucial for on-the-go clinicians. Transferred photos of the patient’s incision would be shared securely and in real-time with the physician as needed to support decisions about antibiotic regimen or wound care and dressing.
In the next generation future state, before discharge, the patient’s mobile application would confirm for providers that she had watched recommended recovery and incision-management instructional videos. The patient’s family would also receive instructions about medications and post-operative care to support their family member’s recovery.
This type of collaborative ‘goal-directed work’ that activates and engages the patient and is orchestrated by the trans-disciplinary team through mobile technology is the essence of the post-EHR era. Even with another stage of Meaningful Use still to come, organizations must shift their focus from CPOE and billing to optimizing data contained within EHRs to improve care processes that will transform clinical quality, financial performance and patient safety.
About the author: Joseph Condurso is the President and Chief Executive Officer at PatientSafe Solutions, Inc. Mr. Condurso has more than 25 years of experience across the patient safety, medical devices, mobile health, and clinical information technology industries.