A Step Forward for the Functional Electronic Health Record

INVITED COMMENTARY:

Computerized methods of capturing, logging, and recalling medical data have existed for decades, with roots extending back to the 1960s with the Health Evaluation Through Logical Processing, or HELP, system.¹ This name is ironically apt today, with clinicians across the country asking whether, despite all of its advances, the electronic health record (EHR) is here to help or to inadvertently create obstacles to patient care. Indeed, studies indicate that physicians spend upward of 6 hours a day interacting with the EHR, including time spent at home and on weekends, contributing to rapidly rising rates of burnout.^2,3 Compounding frustration, the proliferation of health information technology has not always focused on the integration of ancillary systems external to the EHR, such as imaging software, pharmacy programs, and scheduling portals.

In this issue of The Annals of Thoracic Surgery, O’Hair and colleagues⁴ describe the development and validation of a software platform designed to integrate clinical information from multiple data sources, with the goal of improving the management of valvular heart disease. The importance of close follow-up of valvular heart disease, through both serial clinical assessments and surveillance echocardiographic imaging, is well established in clinical practice and guidelines.⁵ Despite this precedent, the authors report that their algorithm identified 17% of patients in a subgroup analysis without documentation of guideline concordant follow-up for their valve disease. Approximately 2.5% of the US population is estimated to have moderate or severe valvular heart disease, the majority of which stems from the types of aortic and mitral pathology evaluated in the current study.^5,6 This gap leaves potentially hundreds of thousands of Americans missing out on appropriate, high-quality cardiac care for their valve disease.

The evolution of valve technology provides patients today with previously unimaginable therapeutic solutions to what would be otherwise debilitating and life-threatening conditions. Yet, our national health information infrastructure allows many eligible patients to fall through the cracks, lost to follow-up, and out of reach for potentially lifesaving interventions. O’Hair and colleagues⁴ demonstrate that integrating data from disparate sources from across the health care enterprise could unlock the potential hidden in the clicks and keystrokes that enter the EHR every day. By leveraging clinically generated data to identify gaps in care, the EHR can contribute to fulfilling the quadruple aims of improving outcomes and decreasing cost while enhancing the patient and provider experience.

Achieving an idealized state of health information technology utilization, however, requires more than just software updates and automated algorithms. First, overcoming compatibility issues between vendor platforms is vital to integrating health information both within and across institutions. This degree of connectivity also necessitates updated data privacy rules for the contemporary era, allowing select providers to access essential patient information when needed and prevent inappropriate access by others. Finally, as clinicians, we must learn to effectively leverage the technologic resources at hand by inputting high-quality documentation and appropriately engaging with clinical decision support. The authors provide a glimpse at a more functional EHR. They leave the door open for the rest of us to make it better.