From the Dean: The highs and lows of the electronic health record
In a follow up to last week’s column – in which I discussed, among other topics, the strong external financial support the faculty at the SMHS generate to bolster our research activities – I am delighted to report that we just learned of the successful re-funding of the Center for Rural Health’s Rural Hospital Flexibility (Flex) Program for an additional five years for a total of almost $4.7 million. Flex is a state-based partnership that works with and assists all rural hospitals in North Dakota to stabilize and sustain their local healthcare infrastructure. Flex provides support to the state’s critical access hospitals (CAHs) and rural health clinics (RHCs). There are currently 37 CAHs and 59 RHCs in North Dakota. The Flex program has been continually funded by the federal government since 1999 – that’s 25 years of funding!
This grant is a good example of the other major focus of external funding that the School generates: support for the service functions of the School to the citizens of the state. Much of the funding is coordinated through our Center for Rural Health and thus much of it is focused on improving healthcare delivery in the rural areas of the state.
And speaking of healthcare delivery, the recent nationwide (and worldwide, for that matter) computer glitch that disrupted air travel also had a chilling (albeit temporary) effect on healthcare delivery. As you undoubtedly know, most healthcare delivery in the U.S. is coordinated through (and documented in) an electronic health record (EHR). On the day of the big computer outage, half the computers in my clinic had blue screens and were inoperative. We were unable to dictate patient notes for electronic transcription as we ordinarily do, and some units had to resort to paper documentation. Fortunately, the hospital information technology staff were effective in getting things back online within a day or so (apparently unlike at some of the airlines), but the entire experience reminded me both of how vulnerable our EHR system is and how much we rely on it.
The experience did lead me to ponder a bit about the promise and the reality of EHRs. The U.S. healthcare enterprise has invested billions of dollars into EHRs, and they certainly have changed how we practice medicine. I (and many others) was not happy when the EHR system was slow or absent during the outage. Yet there are at least two areas where many such systems still fall short of expectations, even when they are functioning normally. The first is called interoperability, and it refers to the ability to share clinical information across different hospital EHRs. Although I can often access at least some of the information stored in other hospital systems’ EHR databases (of course with the patient’s permission!), it remains a more arduous task than it should be.
The second shortfall for many EHR systems is the lack of robust decision support. For example, after a stent is placed in a patient’s coronary artery to alleviate a blockage, I shouldn’t have to remember that it’s a best practice to stop one of the medicines that we use to prevent a blood clot from forming in the stent at one year after stent insertion. Rather, the EHR should automatically ask me to confirm stopping the medicine at one year, and then the EHR should actually discontinue the medicine when I agree to the withdrawal.
But that isn’t the way it works in most hospitals. Currently, it’s up to the care provider to remember and then follow through with the order to stop the medicine. That’s a waste of time for something that should be automated.
The bottom line, though, is that the EHR is an important tool that providers rely on. I just hope that some of the issues that have been identified with current EHR use – especially the two I highlighted – will be resolved in the not-too-distant future.
Joshua Wynne, MD, MBA, MPH
Vice President for Health Affairs, UND
Dean, UND School of Medicine & Health Sciences
