The Inceptary

Patient Care Records

Response to Harvard Business Review Article:

It’s Time for a New Kind of Electronic Health Record

by John Glaser

This is a timely and excellent article about the current state of Electronic Health Records (EHRs). We tend to agree with the concerns laid out in this article related to the lack of expected benefits from EHR implementations, the exclusive focus on healthcare transactions rather than whole person well-being, and the limited prioritization on capturing data that drive medical claim payments. We are also aligned with some of the suggestions regarding future EHR implementations especially those related to building “wrappers” on existing EHR implementations and building EHRs with patient archetype wellness plans.

At The Inceptary we have been developing concepts that we believe are in line with Dr. Glasser’s thinking and include important specifics. We also advocate complementary technology adoption strategies.

In this blog-post we outline our notions of Broad Data Capture and Health Loops, both of which are architected as wrappers to existing EHR implementations. We will also describe what we consider to be problematic with the current wave of EHR (and other clinical technology) adoption and our thoughts on mitigation.

1. Broad Data Capture - The current breed of EHRs require medical professionals to translate their thinking to the constraints of the data schemas, data capture forms, and the vocabulary that are idiosyncratic to individual EHR implementations. This creates inefficiencies in the clinicians’ workflow, probably leading to the reduction of the quality of the data captured as well as the prioritization on data that are required for claim payments. The Inceptary has collaborated with and analyzed physicians’ frustration and burnout due to the additional workload of EHR data entry. We see the need to have an artificial intelligence-powered layer that is able to transcribe physician comments, notes and patient conversations naturally as they occur and then translate the data from these conversations into the data schemas and vocabularies required for individual EHR implementations. This new Broad Data Capture layer is a module that incorporates semantic clinical ontologies, natural language processing and computer vision. This module is based on research on how clinical consultations typically proceed, and the cue words that physicians tend to use. The machine learning components of this module can be trained to personalize the software to the idiosyncrasies of individual physicians and their practices.

2. Health Loops - The current EHRs are tools for managing patients, diagnoses, treatments and claims for physician practices and health systems. Interoperability among EHR implementations is improving, leading to data sharing among physicians, physician practices and health systems. However, very rarely do EHRs serve as tools that individuals can use to manage their own health and well-being. At The Inceptary we have been researching the creation of a module, “Health Loops,” that layers on top of the EHR and can be a tool for individuals. This tool will guide individuals:

• to create health and wellness, goals and plans in conjunction with their clinicians;
• review their health data across multiple EHRs;
• share goals and plans with clinicians, social service providers, family and other caregivers;
• track progress against the plan and revise the plan in consultation with their clinicians.

A key component of this module, is an AI driven engine that makes EHR data across multiple EHRs available to individuals in a manner that can be easily understood. This is important, otherwise clinicians have an additional burden of creating notes that are tailored for consumption by patients rather than other clinicians.

3. EHR Adoption Challenges - The rapid proliferation of EHRs over the last decade has been largely spurred by incentive payments for adoption, additional incentives for the meaningful use of EHR data and financial penalties for not complying with meaningful use requirements. We believe that while this was an appropriate policy prescription, there have been unintended negative consequences. Many EHR implementations were top-down, expensive and driven by schedules dictated by federal regulation. In many instances, this precluded deep analysis of clinician process flows as well as fostering physician sponsorship and the associated change management. Moreover, physicians are not necessarily trained to lead large technology implementations and without this critical leadership, EHR implementations in particular and clinical technology implementations in general, become problematic.

4. EHR Adoption Mitigation - The Inceptary is working on this issue through a two-pronged approach. First, it is working on fostering transformative change in medical education so that clinicians have the capacity to lead technology implementations as well as articulate clinical requirements for technology-based solutions. Second, it is advocating for the creation of templates and tools so that modules such as Broad Data Capture and Health loops can be layered on top of legacy EHR implementations with the requisite process analysis, design and change management. Multiple industries have completed analogous transformations and the later generations of clinicians are already digital natives, as technology continues a rapid evolution to simplified, but powerful use.

Inceptary contributors: Tej Anand, Assistant Clinical Professor, McCombs School of Business, University of Texas at Austin; Algis Leveckis, CEO, GlobalBridgesHealth; Anil Singh, CEO, SherTech Information Services.

We invite you to join us and contribute your thoughts and ideas - please contact inceptor@inceptary.org.