As the former chief medical officer of an EHR company, I have been and continue to be a staunch advocate for EHRs. I fought long and hard for EHR adoption. I am pleased that currently less than 5% of US hospitals are not currently using EHRs.
EHRs are invaluable when it comes to care delivery and excel in a number of areas. They are tremendous repositories of clinical data. They are fantastic order entry systems. They were designed to prevent duplicate testing. They provide prescribing alerts of possible medication allergies and drug interactions. They have rules engines which fire off warnings when patients are past due for certain tests or vaccinations, based on their age and medical history.
As information warehouses, they are passive. Even though they issue clinical alerts, these alerts remain undetected until a care provider first logs into the EHR and then opens up that particular patient’s medical record. It is only then can the warning or clinical alert be viewed. There are many times when messages, alerts, and warnings are critical and time-sensitive. It is not enough to stumble upon an alert. In many cases, these alerts need to reach out and notify the appropriate provider who can efficiently deal with the situation at hand. EHRs need clinical communication tools which can transform the data that is stored within it and in turn transform that data into actionable messages and alerts. EHRs were simply not designed to address a critical area of care delivery: clinical communication and care collaboration.
How can you optimize your EHR to solve these clinical communication challenges?
EHRs are adopting communication tools
EHRs have actually expanded the communication channels available to clinicians. The most popular EHRs support secure email, messages within the EHR (which can be attached to patient records), and pop-ups or general broadcast notices. Some EHRs have even branched out into real-time secure chat applications but these are only accessible while signed into the EHR.
While EHRs provide ways for clinicians to communicate, for the most part these communications are asynchronous. It can be difficult to get real-time feedback when there is a need to clarify messages. There is also no way to escalate communications, confirm that the recipient actually received the message, or communicate with care team members who do not have access to the EHR or are not currently signed into the system. When clinicians need immediate responses, as is often the case in coordinating patient care, clinical communication within the confines of the EHR is not the best solution.
Here are 3 ways you can optimize your EHR to improve clinical communications and patient outcomes.
1. Recognize that EHRs are passive, but can be activated with the right tool
To see an alert or notification in your EHR system, you must log in and open a patient’s chart. The EHR stores this alert, but in order to deliver better care, that stored alert needs to be communicated to appropriate care team members in a timely manner. One example I like to use to illustrate this are alerts for sepsis notifications. For example:
- I make rounds on a patient on the floor at 7 A.M.
- The patient gets an 8 A.M. blood draw of a complete blood count (CBC).
- That result reports out at 9:30 with a white blood cell count (WBC) of 15,000. By itself, it is somewhat elevated but not a critical lab value. However, in combination with a low-grade fever and slightly elevated heartrate, it posts a sepsis notification in the EHR.
- The patient’s chart may not be looked at again until shortly before change of shift when nurses do their documentation—hours have elapsed.
- You only see the sepsis alert when you log into the patient’s record—losing precious time to begin treatment.
A communication platform can take the EHR’s sepsis alert or a critical test result and automatically deliver it to the right clinicians, often a sepsis rapid response team, on their preferred device. The alert includes the clinical context necessary for quick action—key data like the patient’s name, which room they are in, and their MEWS score. The alert is sent in just seconds, enabling the care team to respond in minutes. This automated workflow promotes swift response and allows sepsis treatment to begin quickly, potentially preventing patient morbidity and mortality.
2. Help clinicians from drowning in their EHR inbox
Most physicians experience fatigue in as few as 22 minutes when working with electronic health records, according to recent research. Overflowing EHR inboxes require clinicians to spend valuable time they are not being reimbursed for sorting through notifications.
One solution is to triage these messages by differentiating the less urgent or non-critical messages from those that need attention. The EHR is good at capturing specific moments in time. A clinical communication platform helps care teams communicate in real time.
Clinicians need to be able to quickly and easily identify and respond to the most critical messages and, if they cannot respond to the message, be able to escalate it to someone else who can. Enhanced communications, that can flow in and out of your EHR, can connect staff more quickly and efficiently for important conversations and improve clinical workflows, patient transitions, and care delivery.
3. Use a solution that can support multiple devices and multiple staff members
Use a clinical communication platform that is multimodal and offers the flexibility care teams want and need. With support for secure messaging, voice, alarms, and alerts across end-user devices, including smartphones, pagers, and Wi-Fi phones, caregivers can receive messages that are initiated by the operator, staff members via the web, patient monitoring systems, and other sources—and receive them on their device of choice.
One of the downfalls of the EHR when it comes to care team collaboration is that they do not support all members of the care team. The only people who have access to the communication tools within the EHR are those who possess login credentials to the system, which may exclude some key roles including transport, environmental services, food services, housekeeping, etc. As care teams grow larger and more diverse, it’s increasingly important that communications encompass everyone on the entire spectrum of care.
EHRs were not designed to support clinical communication
EHR systems are essential and have been tremendously valuable investments on the part of hospitals and health systems across the country. They have effectively ushered healthcare into the digital age. While they offer tremendous benefits to patient care, there is one key area where EHRs falls short—clinical communication and collaboration, especially for information that needs to be transmitted, received, acknowledged, and acted upon rapidly.
Healthcare organizations need a communication platform that is complementary to their EHR. One that enables clinical messaging and collaboration among all members of the care team to support the real-world communication needs of clinicians across the organization.