Editor's Corner: EHRs are no substitute for basic communication

Marla Hirsch

Two recently published and seemingly unrelated studies illuminate even further some of the potential of electronic health records. But they also unwittingly highlight one of the more basic problems in healthcare.

In one study, Vanderbilt University researchers reported how EHR utilization data can be used to identify previously unrecognized provider teams working together to coordinate patient care. Care coordination is one of the hallmarks of health reform, so anything that improves collaboration is a step forward.

The study found that although some information, such as claims data, will reveal some patterns of care coordination, EHR utilization data uncovered a lot of ad hoc, "strong" collaborations. The researchers suggested that the patterns of collaborative care uncovered can be reviewed administratively and integrated into management practices.

The other study used EHRs to tackle quality improvement analysis, focusing on, but not limited to, failure mode and effects analysis (FMEA) to improve patient safety. FMEAs use “process maps” to identify flaws in high-risk processes, analyze how a process could fail and prioritize interventions to prevent patient harm. The better the process map, the better the information gleaned from it and the better the outcome. 

The researchers compared a typical process map for a high-risk situation (discharge from a cardiac unit) to the information in an EHR and discovered that the EHR provided more detailed information than the regular process map. For instance, it provided information from sub-processes, such as EHR notes, orders and forms, and identified 12 additional provider types involved in the cardiac unit. Moreover, 35 percent of providers involved in care on the unit were “unexpected” in the process. All of this additional input into the analysis would be helpful in the quality improvement activities and ultimate patient safety efforts.

We’ve known for years that the data in EHRs can be used for a multitude of secondary uses, such as research into identifying at-risk patients, determining who would be well suited to participate in clinical trials and the like.

These new studies point to even more opportunities to harness EHR data in new ways to improve clinical care and patient safety.

But why did it take an EHR to unearth some of this information? Why did it take an EHR to determine that there are more providers involved in discharging patients from an inpatient cardio unit than first expected? Why did it take an EHR to uncover that the same providers, whether by specialty, personal relationships, or being scheduled in a hospital at the same time, end up informally working together to coordinate care?

Why not simply ask?

  • “Hey, are there any other staff members that we should include in our analysis of risks on this cardio unit?”
  • "How did that provider end up providing care here?“
  • "Are there particular clinicians you seem to end up working with regularly when coordinating care in our hospital? Should we designate the three of you a team to make patient care easier?”

It’s one thing to use EHR data to cull genomic information from arcane lab reports or to identify patients at greater risk of mutated cancer.  That’s very hard to do manually. And this use of EHRs to make future analyses and operational management decisions is great. Anything that improves patient care and safety is a positive development.

But EHRs are not a substitute for basic communication, especially in the real world, where stakeholders are already hard at work developing teams, coordinating care, analyzing risk and improving patient safety.

EHRs are a powerful tool, but still just a tool.  They should not take the place of simple human interaction. - Marla (@MarlaHirsch and @FierceHealthIT)