Penn Medicine’s new transformation project looks to fill the ‘middle space’ between EHRs and clinicians

Doctor computer medical records
Citing slow progress from vendors, Penn Medicine wants to close the gap between EHRs and clinicians. (Getty/BrianAJackson)

Impatient with the current progress of electronic health records (EHRs), one of the nation’s foremost academic medical centers is taking matters into its own hands.

Last week, Penn Medicine—which operates as the health system under the University of Pennsylvania—launched a new initiative aimed at transforming EHRs into “more streamlined, interactive, smarter tools.”

That effort will focus primarily on what David Asch, M.D., the executive director of the Penn Medicine Center for Health Care Innovation, calls “the middle space” between EHRs and clinical productivity.

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“It’s about the creation of some middleware that takes the EHR products created by large companies and creates interfaces that are better,” he told FierceHealthcare. “It might ultimately be absorbed by those [EHR] companies, but I don’t think we can wait. I don’t think we should force clinicians to move to the EHR when we can be a part of the solution to help bring the EHR to them.”

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Part of Penn Medicine’s effort is a focus on using EHRs not just as an administrative or documentation tool, but also pushing it into the care delivery arena. That involves shaking up the traditional health system approach that says clinicians simply need more education to unlock the unused functionality of EHRs. The notion that clinicians need help becoming the “master of the EHR” often rubs them the wrong way, Asch says.

“What you’re effectively saying is the EHR system is master to you and you have to move to it,” he said. “What that really means is, we’re going to help you become a slave to it.”

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Of course, it begs the question: What can one system alone do to make such a monumental shift? The impact, Asch admits, may be limited. But he says the system can make significant changes within its own orbit.

Already, Penn Medicine has found notable success with its “Nudge Unit,” launched in 2016. Using a foundation of behavioral sciences, the research spinoff has uncovered ways to improve influenza vaccinations and cancer screenings and increase generic prescribing rates among physicians using alerts embedded into the EHR.

The notion that clinicians could subscribe to patient alerts, an approach Asch touted recently in a NEJM commentary, is the type of “middleware” that could bring clinicians and the EHR closer together. And while issues like alert fatigue are certainly a concern, healthcare providers can’t wait any longer for EHR vendors to set the pace of transformation.

“We can either join the chorus and complain about EHRs or we can do that and try and do something about it,” Asch said. “This is a little bit of a call to arms not just for ourselves but for the rest of the community.”

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