We have a small library in the graduate students’ office of the Intelligent Systems Program. Over 30 years of its existence, it has collected various visions and hopes about how applications of AI would change different fields around us. One such record is the Institute of Medicine committee report on improving the “patient record” from 1992. It emphasizes the importance of using Electronic Health Records for decision support systems and supporting data-driven quality measures for the then emerging technology. While the last few years have seen a rapid increase in EMR adoption, there hasn’t as much progress towards the goal of using this data for improving care. In contrast, however, physicians’ experiences tell a very different story about how EMRs end up getting in the way of taking care of their patients.
Why are EMRs causing harm when they were supposed to help?
There are many potential reasons for physicians’ problems with the current EMRs, but the main challenge in building them is to provide effective solutions for many complex tasks and scenarios involving collecting, finding and displaying large volumes of patient information. Physicians often like to compare their EMR to large wooden cabinets with lots of drawers and difficult access to the information they need. Documenting and finding the right pieces of information becomes a massive task as the information grows. And all these problems are only going to increase in the future. This is because we are moving towards collecting more and more data. Also, we can expect physicians’ processes to become more sophisticated as we advance towards solving harder health problems.
The University of Pittsburgh Medical Center has over 9 PB of data, which is doubling every ~18 months. More innovation in medical devices and sensors, easier documentation procedures, patient reported outcomes… all are going to further add burden to the EMR software. We also need to ensure that the methods for capturing this data are convenient for the care providers, without causing significant disruptions in taking care of the patients. Free-text reports offer easy mechanisms to capture rich information that can be easily communicated. But, we need to build better systems that can help analyze this information. More data can only provide favorable outcomes when we provide appropriate ways of handling and analyzing it.
Team based care
Sophisticated health care practices requires a team based effort. All of which must be coordinated by the EMR software as the primary means of communication between the team members. However, not all teams are interested in the same pieces of information and the current practices result in an information overload for the physicians. Some physicians come up with ad-hoc processes outside the EMR system to cope with these problems. For example, we often find ICU physicians using manually curated signout notes to communicate important information to their team members. These are examples of important pain points for the physicians that must be identified and addressed.
Technology to the rescue?
We have seen these problems in computer science before. We even trace the birth of the field of Human-Computer Interaction to ideas like MEMEX, which hoped to solve some of these very problems. We also have made a lot of progress in AI since then, which provides us practical tools to build real solutions. And we are employing some of these in EMRs as well – like Dragon for dictating patient notes, aggregating patient information among others. But, one could still claim that the development of EMRs “has not kept pace with the technology in other domains”. We have many open problems in the way of making the EMRs work better for everyone. As much as pop culture has left us desiring for things like the Star Trek Tricorder, what we really need instead are tools that can help make physicians wade through the sea of information and make better decisions. A more recent (2007) Institute of Medicine report envisions a Learning Health Care system that allows intelligent access to patient information. The role of the physicians must evolve towards becoming better data managers and analysts. And we need computer scientists and engineers to find and solve some of the problems along the way.