Electronic Health Records (EHR, EMR)

Penn Medicine is pursuing a new initiative it says will innovate electronic health records for 21st Century medicine. The goal, officials say, is to make the technology more interactive and responsive to clinicians – nudging the EHR into a new era where it's not just a documentation system but a crucial tool for care delivery. WHY IT MATTERS Since EHRs have become ubiquitous over the past decade, they've grown into an intrinsic part of the ways healthcare is administered. They've also earned no shortage of annoyance, if not downright scorn, from many clinicians frustrated by how they impact their jobs. As Penn Medicine explains, many physicians simply see EHRs as "static, digital remakes of paper charts that can increase workload, contribute to burnout and create barriers to delivering high-quality patient care." And oftentimes that's exactly what they are. But as is often the case, much depends on how such tools are used. So Penn Medicine leadership has undertaken a multi-pronged approach to making EHRs more responsive to clinicians and streamlining them to work better for better outcomes in the era of precision medicine and population health management. The Penn Medicine Nudge Unit – billed as the first behavioral design team developed at a health system – is key to the mapping of these new approaches to the EHR experience. For instance, it has devised new tweaks for Penn's Epic system designed to help ensure clinicians prescribe statins for their cholesterol patients, get cardiac patients referred for rehab after heart attacks and only order advanced imaging tests for the patients who need them most. David Asch, MD, executive director of the Penn Medicine Center for Health Care Innovation, has previously explained how behavioral economics and psychology are key to engaging patients to make meaningful changes. The same holds true for physicians, he says, which is why he's advocated for EHR customizations that, among other things, enable and encourage doctors to "subscribe" to their patients' clinical data, gaining social media-like updates in real time when certain interventions are needed. "Ultimately, we need to move past the idea that the EHR is just an administrative tool, and see it as a clinical tool – like a scalpel, or a medication, or an X-ray machine," Asch said in a statement announcing the new project. "We judge these tools by the degree to which they facilitate good patient care, and we should be judging the EHR against the very same standard." THE BIGGER TREND Much has been said, here and elsewhere, about the "post-EHR era," but Penn Medicine's efforts appear to be intent on making it a reality there – boosting the ability of IT systems to deliver enhanced care in the 21st Century. No longer just a data repository or a glorified billing system, the EHR – when properly designed, configured and used – could have a huge impact on how care is delivered, especially as the complex new era of connected devices, patient-generated health data, genomic medicine and artificial intelligence continues to come into focus. A chief goal at Penn Medicine, officials said, is to alleviate if not eliminate the need for clinicians to spend undue time looking for needles in data haystacks, getting pertinent patient information in a more "actionable, tailored manner." That's why the health system has also launched a new innovation contest designed to get teams from across Penn Medicine to identify the lowest-hanging fruit for EHR transformation. IT professionals, data scientists, educators and others will work with clinicians and staff to help conceive and refine various design and usability improvements. In addition, new so-called "sprints" – collaborative clinical workgroups to help to streamline and improve EHR interactions and engagement with email and  digital media – will be a key component of the new initiative going forward. ON THE RECORD "We recognize that EHRs are no longer just part of how clinical care is documented, but they are central to how clinical care is delivered," said J. Larry Jameson, MD, dean of Penn's Perelman School of Medicine, in a statement. "Increasingly, health information technology plays a foundational role in each domain of our work: patient care, educating the next generation of physicians and scientists, and biomedical research." Ralph Muller, CEO of the University of Pennsylvania Health System added: "Everything that shapes patient care should be designed to support the best possible outcomes. Electronic health records are a natural focus because they connect to everything we do." Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com

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With a proverbial flip of the switch at three locations in Florida and Arizona, Mayo Clinic has completed its $1.5 billion Epic electronic health record implementation, linking all Mayo sites on an integrated EHR and revenue cycle management system. WHY IT MATTERS The Mayo Clinic rollout, called the Plummer Project, in honor of Henry Plummer, MD, who developed a patient-centered health record at Mayo in 1907, is one of the largest, most complex and most expensive Epic implementations ever. First announced in early 2015, the initiative, which sought to replace the health system's existing Cerner and GE systems, had been under consideration for years, said Mayo Clinic CIO Cris Ross. "We really believe that an integrated EHR, across all of our organizations, can help us with that core mission of meeting patients' needs," he told Healthcare IT News at the time. Ross predicted then that rollout would take "about four years to complete." Given that the first two-dozen sites went live in Juy 2017, it's coming in ahead of schedule. There were several milestones along the way, notably go-lives at Mayo Clinic Health System in in November 2017 and Mayo Clinic in Rochester this past May. All told, the project depended on the expertise of nearly 500 IT staff. Now, some 52,000 Mayo employees are using Epic across 90 hospitals and clinics in the Minnesota, Florida and Arizona. "The project is highly complex due to the number of specialties and subspecialties involved," said Ross in another interview earlier this year. "We are not only focused on building and delivering a converged technical solution. We are also invested in the people side of change to support them in adopting, utilizing, and becoming proficient in the Epic system. This is being accomplished through a comprehensive change management strategy." WHAT IS THE TREND Mayo Clinic says the complexity and expense of the project were worthwhile investment for a single unified system that connects patients and providers across the health system, enabling easier access to clinical and billing information regardless of location. More and more, large U.S. health systems such as Mayo are gravitating toward either Epic and Cerner, and the same trend is now also playing out overseas. Other major Epic deals this year include Chicago-based Advocate Health Care and Trinity Health in Michigan. ON THE RECORD "Having one integrated system builds on our core mission of putting the needs of patients first,” says Steve Peters, MD, co-chair of the Plummer Project, in a statement. "This will enable us to enhance services, accelerate innovation and provide better care." "The commitment and expertise of outstanding Mayo staff, Epic colleagues and implementation partners brought us to this day," added co-chair Richard Gray, MD. "We envision even greater collaboration among experts in delivering the patient care, research and education that are hallmarks of Mayo." Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com

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