June 12, 2017 Updated: June 12, 2017 3:19pm
The health care industrial complex has spent billions of dollars and untold amounts of time trying to make medical records as flexible, invisible and unobtrusive as possible for patients and clinicians alike.
The results will be well worth the expense, the thinking goes, if the records — tracking patients in the vast and complicated health care system — could help clinicians spend more time caring for people and less on paperwork.
But after nearly two decades of concerted innovation, amid a push to do away with paper records, many physicians say they’re still hamstrung by issues that have dogged them for years. We’ve replaced the medical chart with a patchwork of systems that impose on doctors’ precious time and have yet to deliver clear improvements.
In a report last year by Medscape, a trade publication, 57 percent of more than 15,000 physicians surveyed said that having to grapple with electronic records was reducing the amount of face-to-face time they were able to spend with patients.
“We’re not at the promised land,” said Dr. R. Adams Dudley, a pulmonologist and the director of the Center for HealthCare Value at UCSF.
Change may be coming. Beyond improving documentation for doctors, large health systems are taking advantage of the troves of patient data to make better decisions in critical situations.
For hospital patients, Kaiser Permanente of Oakland has developed an algorithm that factors in a combination of vital-sign monitoring with data pulled from electronic medical records to predict the risk of rapid deterioration.
If the algorithm deems a patient to be at risk, hospital staffers are sent an alert.
“If we can identify some, many or all of those patients before they experience that (negative) event, and can help avoid that event, then the view is one can reduce complications and reduce morbidity and mortality,” said Dr. Pat Conolly, a Kaiser executive who oversees information technology efforts. The early alert system, she said, will be implemented across all Kaiser hospitals.
At UCSF, Dudley’s team is developing a similar predictive modeling program that will be used to determine if a patient needs to be put on a breathing machine, as well as the patient’s probability for surviving in an intensive care unit. That matters, he said, because families must decide how much they want their loved ones to endure.
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