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Para-EHR Clinical Data Not Being Captured and Keeps Getting Bigger

Posted Jan 15 2014 12:00am

An interesting question to ask regarding the future of EHRs is how much relevant information about patients that is known by clinicians is not captured by current EHRs. A recent article raised this question and assigned a name to this non-captured, amorphous blob of information -- para-EHR (data) (see:  Is the EHR really necessary? ). Below is an excerpt from the article:

A ...panel discussion at Partners HealthCare's 10th Annual Connected Health Symposium [concluded] that the important information for a patient's care actually exists outside the electronic medical record. With mHealth becoming the norm instead of the exception, the panelists said EHR vendors will have to find a way to modify their products to focus on data that the patient and his or her care team want, or they'll become obsolete."....The session....focused on what Watson termed the "para-EHR," which he defined as all of the phone calls, texts, e-mails and other doctor-doctor and doctor-patient communications that aren't entered into the EHR. They could include everything from Skype chats between doctors to Post-It notes to data residing on mobile devices and sensors. Watson....estimated that 70 percent of his work with patients is conducted in that informal region outside the EHR. His fellow panelists put that number closer to 90 percent. "The systems that we have today are not geared toward clinical efficiency," said Rasu Shrestha, MD, UPMC's vice president of medical information technology, who said EHRs are instead geared toward billing. He called the para-EHR "this other bucket of information" that more closely resembles the doctor-patient encounter. "Whatever it is today, it's going to get bigger," added Kent Gale....The ability to communicate and capture data in real time through mobile devices and wearable sensors, they said, has made the typical EHR obsolete."When the digital age collided with healthcare, which I think was around 2007, healthcare stumbled heavily," Watson said. Shrestha added: 'We focused on where the money was as we moved from analog to digital." 

In a recent note, I suggested that many EHRs are an efficiency drag on hospitals' key employees, nurses and physicians (see: OIG Says Cut-and-Paste in EHRs Can Lead to Medicare Overcharges ). My view is that they have not been designed with efficient clinical workflow in mind. This sentiment was echoed by Rasu Shrestha, MD, UPMC's vice president of medical information technology, in the article above. He suggests that the EHRs that we have today are not geared toward clinical efficiency but rather for efficient billing. The panelists quoted above estimated that some 70-90 percent of physician interactions with patients are not being captured by EHRs. I also suspect some of the data that is actually being captured by EHRs these days is redundant or erroneous due to the cut-and-paste capabilities of the systems (see: OIG Says Cut-and-Paste in EHRs Can Lead to Medicare Overcharge s). 

An interesting question raised by this discussion is whether the para-EHR data discussed above (e.g., phone calls, texts, emails) is actually capturable by any currently available system. The answer for the future probably lies in some sort of dedicated physician tablet that will be used for all physician-patient interactions with documentation stored in the cloud. Of course, this approach will require a revamping of EHRs plus some discussion of whether storing all clinical data has some real payoff in the quality of care.

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