Even with the current limitations of electronic health records (EHR), Vanderbilt University School of Medicine has tapped into physician ingenuity to overcome problems with the technology and access the wide range of data available to improve patient care.
When he got to Vanderbilt several years ago, Jesse Ehrenfeld, MD, an anesthesiologist and AMA board member, created a team that was focused on helping physicians better use technology that was already at their fingertips.
“We have all of this data, we click buttons and check off boxes, and we enter in fields, but we never get anything back in return,” Dr. Ehrenfeld said. “The data lives somewhere, but nobody knows where it is, and nobody can get to it in a way that helps me take care of patients—that was the No. 1 complaint that I heard from my clinician colleagues.”
As a result, Dr. Ehrenfeld’s team has been focused on developing approaches and infrastructure to “bring that data alive,” he said, “to make it actionable and allow our clinicians to use it to work more efficiently and effectively.”
Here are two solutions he and his colleague Johnathan Wanderer, MD, have developed to assist in clinical decision-making:
- Tracking outcomes. “There is no shortage of quality reporting that happens at hospitals around the country,” Dr. Ehrenfeld said. “We, in fact, are drowning in metrics. There are CMS metrics … payer metrics, Joint Commission metrics—all these things that we have to report out.” “But what comes back to the clinicians is rarely meaningful,” he said. “It’s typically stale data that’s six months to a year old that doesn’t have the capability to really help me understand what I can do to make the experience better for a patient or to improve my practice.” Drs. Ehrenfeld and Wanderer's team at Vanderbilt created an infrastructure that pushes actionable information back to the clinical faculty on a weekly basis so that they can see how the patients are doing. “Were there adverse events, were there good outcomes?” he said. “And then we can use that information to feed things back into the system.” “It comes out as a simple email that has a list of the patients, a little description of who they were so you can remember who you saw and then the outcomes of interest,” he said. “If you want to dive in, it’s one click that takes you to a secure website, where you can get detailed information about exactly what happened.” “I took care of a patient who had a hernia surgery and saw in my weekly outcomes email that she’d been readmitted,” Dr. Ehrenfeld said. He wouldn’t have otherwise known because she was doing fine after he did his post-op check. “But there was a complication that happened a few days later.” The next day, Dr. Ehrenfeld went to the surgeon he had been working with and it led to a conversation about what was going on. “It brought the surgical team back together with me so we could brainstorm about how we ended up with this readmission,” he said, “and how we could improve.” “This technology helps physicians see what they need to see to make better decisions,” he said. “It closes the loop in a way that brings information that’s timely back to the physicians and lets us really leverage the information that we are already collecting.” “The data is all there,” he said. “It’s not like there’s a tech or a research assistant or a clerk who’s looking through charts and calling patients. We’re automatically extracting data out of the EHR. It’s lab data, encounter data, quality data—we’re just bringing it together in a format that’s useful to clinicians so that we can use that to improve our practice.”
- Preparing for tomorrow’s patients. Similar to the above example, physicians who are preparing for the next day’s patients generally have to cross-reference scheduling information with EHR information and clinic information to be able to identify information the patients they’ll be taking care of, how they need to prepare and whether they need additional data. At Vanderbilt, they’ve developed a way to do that for the clinician by cross-referencing all of the data sources and bringing them together. “[We] send every clinician an email with the patients they’re seeing the next day that has information that will be useful to them,” Dr. Ehrenfeld said. “Types of cases, who they’re working with, the surgical staff and issues that are unique to those patients—that way you can then focus on what’s most important.” “Every day in every hospital EHRs feed data into data warehouses,” he said. “The opportunity here is to pull together informatino from across multiple sources, in ways that make it useful and save people time. We’ve developed a team of programmers and data analysts that have built an environment that automatically brings that data together in a way that allows the system to then generate these kinds of reports.”
Beyond Vanderbilt, Dr. Ehrenfeld is involved in expanding the possibilities of EHRs to physicians across the country. SMART Health IT, an open, standards-based technology platform enables innovators to create apps that seamlessly and securely run across the health care system. Using an EHR system or data warehouse, patients, physicians and other health care professionals can draw on a library of apps to improve care, research and public health.
Dr. Ehrenfeld sits on the advisory board and provides input and guidance about how the technologies can be further developed and how the concepts can be brought forward to enable broader audiences to use them.
“The genomics of cancer are very complicated,” he said, pointing to an example project as part of SMART health IT. “A colleague of mine at Vanderbilt has developed an app to help physicians have the conversation in a less complicated way with patients.”
Jeremy Warner, MD, an oncologist at Vanderbilt, built an app, SMART Precision Cancer Medicine, which compares a patient’s diagnosis-specific somatic gene mutation to a population-level set of comparable data. Specific links within the app connect to Gene Wiki, My Cancer Genome and HemOnc.org to allow the physician to talk with the patient in a way that helps them understand their risk and treatment options.
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- Learn how one practice in Minnesota used their EHR to enroll patients in a diabetes prevention program
- At the 2016 AMA Annual Meeting, Dr. Ehrenfeld detailed another technology solution from Vanderbilt that streamlines the surgical timeout that is directly tied to their EHR, and learn how Kansas developed an interoperable EHR system statewide
- Vanderbilt has also established a competency-based education program within their medical school. Using open-source software, they created a complex e-portfolio system that charts students’ performance across a core set of competencies based on the Accreditation Council for Graduate Medical Education’s graduate medical education milestones.