3 upgrades EHRs need to integrate CDS, streamline workflow

Electronic health record systems currently can leave much to be desired when it comes to integrating clinical decision support and streamlining workflows, and there are many enhancements needed for the next generation of EHRs, according to a recent research paper.

"The vast amount of information and clinical choices demands that we provide better supports for making decisions and effectively documenting them," according to the authors of the paper, published in the Journal of Medical Internet Research (JMIR).

In fact, a team of University of Missouri researchers found that clinical notes in EHRs need to be redesigned to match physicians' workflow and information needs, FierceEMR previously reported.

Three of the upgrades that should be included in future EHR systems, according to the authors from Beth Israel Deaconess Medical Center, Yale University, New York-based Center for Urban Science and Progress and University of Virginia's Center for Wireless Health, are:

  1. Data incorporation: Data notes should include "bidirectional data streams," which the authors write are electronic notes that offer data streams for the whole EHR database and vice versa. The system should be automatic and an "intrinsic property of clinical information systems." In addition, the systems should account for free text and data that is not structured, and to do so will need advanced processes that could include natural language processing and machine learning.
  2. Monitoring systems: For proper decision support, monitors must interact with the EHR in a bidirectional fashion. In addition, sometimes vital signs are technically abnormal but not abnormal for the patient given the context of their condition, which the display should reflect. "It also might be desirable to use a combination of accumulated historical data from the monitor and the EHR to formulate personalized alarm limits for each patient," the authors add.
  3. Formulation of the note in real-time: While currently, free text can be clunky, the authors write, it does offer "a needed narrative element into the otherwise storyless EHR." However, more complex systems will need to be created so the computer can develop a "processed interpretation of the text." Until that time, the authors add, clinicians can lessen confusion by keeping free text entries to a low volume.

The authors also say that there is support in the government for such advances to EHRs, noting the Office of the National Coordinator for Health IT's 10-year interoperability roadmap. They say an EHR that supports workflow and clinical decision-making is the key to an interoperable health IT system that improves individual and population health.

To learn more:
- here's the JMIR paper