Of Documentation, Outcomes, and AMIA 2018.
Over the years, we’ve heard plenty of prominent outlets, physicians, residents, and journalists lament over the burden and burnout that arose from the implementation of electronic health records in the U.S. health care system.
Yesterday morning, surgeon and author Atul Gawande published a longform piece in the New Yorker about his and his hospital’s experience going through the steps of deploying, training, and troubleshooting a new EHR system for seventy thousand employees. From long hours learning the documentation and search process, frustrations over where to click, read, and record, and spending more clinic time typing into LED screens instead of palpating spleens, Gawande found that much of the promise of informatics in medicine — “greener, faster, better” — had instead made physicians slower, tired, and confused.
We experienced this firsthand, as trainees and as observers.
The end of each day in hospital clinics is eerily silent; only broken by the uncoordinated clatter of keystrokes behind monitors lining the walls of the back office. Resident physicians sit silently behind desktops, furiously typing away to finish their notes, transfers, and orders for the day. Doctors now spend twice as much time behind a computer as they do with patients.
Similarly, nurses, medical assistants, and other health care staff have been increasingly relegated to desk jobs. During my twelve weeks working at a community health center, I saw a medical assistant spend every Monday sitting behind a desktop with a stack of papers listing each patient’s name and phone number. She spent the next eight hours calling each patient to confirm or reschedule their appointment for the next day, slowly crossing off each name as she moved down the list.
Fundamentally, in a field otherwise governed by sensitivity, specificity, and p-values, informatics in medicine has increased noise at the expense of signal. Short, handwritten notes for a patient visit have been replaced with pre-populated 2-page templates that appear with two clicks. While EHR vendors have been doing better to build tools that help reduce the burden of documentation for doctors, lengthy, often duplicative, templates make it much more difficult for other doctors to identify some of the key problems and histories that patients have. Dozens of visits, pages of notes per visit, and personal differences in documentation and semantics have made recreating a patient history akin to finding a needle in a digital haystack.
#AMIA2018
As the 2018 American Medical Informatics Association Annual Symposium kicks off in our backyard of San Francisco this week, our team at Memora Health hopes to highlight where information technology in health care has fallen short, where promise remains bright, and what we should focus on to get there.
So much of what we need from patients is as simple as asking them. Yet, we often wait until they come to the clinic to ask basic questions and then spend twice as much time double checking their responses with the deluge of notes in their health record. While the digitization of health care has increased the amount of noise that clinicians must wade through, its on us to amplify the signal and make their jobs easier.
Whether it’s better visualization of important patient information so doctors don’t have to skim haphazardly through template notes, more robust collection of patient-reported outcomes to help contextualize how patients are feeling in the context of their illness in real-time, or simply automating paperwork that keeps clinicians at their desks rather than with their patients and families, we believe that clinician-guided software can realize the same promises that many early adopters of EHR technology hoped for, fundamentally improving patient care AND the clinician experience. At Memora Health, we’re designing, iterating, and deploying a suite of products alongside clinicians and patients, and aim to automate many of the same manual, frustrating tasks that depersonalize patient care, while making the time that clinicians DO spend with their health records more informative and — dare we say — pleasant.
Clinicians and informaticians at AMIA 2018, reach out at info@memorahealth.com! We’d love to hear from you and work together.
Memora Health is building the operating system for care delivery that implements intelligent, streamlined workflows and revolutionizes the patient experience outside the care setting. We offer a smart end-to-end platform that unifies fragmented health care data to enable providers, payors, and life science companies to automate care delivery operations — from patient communication to documentation to reimbursement. We uniquely use artificial intelligence to digitize existing care delivery workflows, giving clinicians infrastructure that learns from every encounter they have. Memora supports a full suite of virtual care systems from automated patient intake and scheduling to remote monitoring and care pathways to billing and documentation. Memora is backed by Andreessen Horowitz, SV Angel, Kevin Durant, Martin Ventures, and several healthcare strategic groups.
