TECHNOLOGY
several innovations using currently available technologies can help improve efficiencies, cost savings and improvements in user experiences for both patients and clinicians.
The usability of EHRs and automating data gathering The digitalisation of patient case notes (conversion from paper-based to completely electronic records) is certainly an important area given its potential advantages which include the avoidance of treatment delays and savings made in lieu of their storage and transportation costs, not to mention reducing the risk of losing data, misplacing notes and security breaches (anyone could read them with no audit trail).
The focus here, however, is not simply on the storage format of patient data, but its usability. This means the efficiency, effectiveness and ease with which data is collected and utilised. In its simplest form, usability of a single data item (e.g. blood
pressure reading at a given clinic visit) is the process of measuring/recording that data item and that of its re-call/re-use in clinician- and patient-facing media. This is an area where future technological innovations can make a large impact in improving the efficiency of care as well as user experience. Electronic health records (EHRs) aim to replace paper case notes entirely through providing a digital platform for documentation and use of patient care data (a virtual record of patient care). In most cases, however, their designs simulate paper case notes perhaps reflecting the need to ensure continuity in use and providing users an ‘equivalent’ experience to using paper case notes. This is a pragmatic solution as staff re-training for any new system is an important consideration. In the NHS, however, the process of digitalisation of case notes remains incomplete and paper case notes are still used alongside EHRs creating a parallel
system of recording patient encounters. Hence, far from solving the problem of improving data flow, it has inadvertently created a situation where users (e.g. clinicians involved in patient care) would need to rely on both systems to build a complete picture.
The data storage format is also
Figure 1. A model of automated data collection, display and storage system in an outpatients clinic using a series of smart devices connected to a central hub.
Figure 2. An app for patients under the care of nephrology services in UK. From Hazara et al.7
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an important consideration in future developments of EHR technologies. As discussed above, storing data items or care plans (e.g. clinic letters) in static documents (rather than in the dynamic form) does not necessarily improve the usability of individual items of data. A single blood pressure reading recorded at a clinic visit may only be useful for immediate use if stored in ‘PDF’ files, unless the user knows to navigate their way to that file. The opportunity to trend-analyse serial blood pressure readings and communicate these trends to other clinicians and patients is also lost with this structure. Various other examples of this exist, such as doses and frequencies of medications, which are difficult to trend and correlate with intended outcomes of their use. Graphical representation of changes in these parameters could bring additional patient benefits. Hence, EHRs in their current form, which are structured as repositories for information displayed in static format have only achieved partial success in user satisfaction and should be seen mostly as steppingstones towards full digitalisation. Truly useable and dynamic data are those recorded in separate fields (to use a database term) and are amenable to querying, trending and transforming. Inputting such data is time consuming and requires automation in data entry and labelling. Here, innovation in ‘smart’ devices that connect to a central data hub, automating the process of data collection and transmission, could result in improved efficiency by bypassing the need for manual documentation. A smart data hub can help process/sort data items and present outputs in various formats ready for the end-consumer (e.g. clinicians). The same system would then store key data in the patient’s EHR through a dedicated programming interface. A hypothetical scheme of how a series of automated smart devices can help improve patient flow in an outpatient clinic setting is shown in figure 1. In the settings of a dialysis unit, similar systems already exist automating the collection, entry and display of key patient data in real-time (e.g. weight, blood pressure and the recording of dialysis data); e.g. Fresenius Therapy Data Management System.2 Smart devices that communicate with mobile phones are readily available in the market; yet health services have been slow in adopting these. Moreover, the integration
NOVEMBER 2020
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