It’s one of the conundrums of modern life that time-saving technology sometimes takes more time than it saves us.

For instance, email is quicker than a phone call, and yet office workers spend an average of 4 hours a day checking their email. We're somehow spending so much time managing the technology of connection that we have less time to actually... connect.

And medicine is no different — healthcare providers are spending dramatically increased times interacting with EHRs/EMRs and plummeting hours with patients. 

It’s disturbing but true: a study of first-year residents shows that 43% of their time is spent interacting with electronic medical records — that’s 3 times more than they spend interacting with patients. In fact, according to JAMA, they spend nearly 90% of their time away from patients.

The problem with this time split isn't so much that it's not efficient. The problem is that healthcare's most valuable assets — the human beings who are our healthcare providers — aren't being used to their "highest and best" potential. That matters for the output that we see from them (in terms of quality of care and innovation) as well as for the long-term sustainability of healthcare (considering the sky-high rates of healthcare provider burnout.) 

It's easy to look at this and bemoan the use of technology in medicine. Perhaps technology is inherently distracting, alienating, and time-consuming?

Personally, I don't think so. Technology can detract from our time with patients or it can add to it. What makes the difference is whether the technology we are using has been thoughtfully designed, intuitively structured, and whether it integrates into our workflow. The answer to all three of those questions for most Electronic Health Records is a resounding "no," which is why EHRs have become such a time-sink and distraction for doctors.

The truth is that we can’t go backward to an era of black doctors’ bags and paper medical records. But we can go forward to an era of holistic, integrated technology. And I think that as leaders in medicine, it's our responsibility to demand technology that supports human engagement, the art of medicine, connection and collaboration with our colleagues, and the highest and best use of our time. This demand of our technology is far from frivolous; it's key to our ability to uphold our commitment to our patients.

Thankfully, I think that there are subtle signs that healthcare is beginning to swing its huge pendulum back toward human interaction and human-scale healthcare. As Dr. Zimlichman wrote recently, even hospitals themselves are becoming a "technology" that is unwieldy and shows signs of shrinking in significance: 

“The hospital as we know it—a medical center crammed full of patients, beds, equipment, medical staff and service workers, and much more—is an expense society can't really afford anymore... Other industries—retail, banking, finance and others—have long used digital tools to enable clients and businesses to collaborate and connect, anytime and anywhere. Those tools are now available to the medical industry—and given the constantly ballooning costs of care, the hospital is a perfect candidate for its own digital revolution.”

In other words, its possible that we are actually at the peak of technology's negative impact on medicine. And that as technologies mature and healthcare evolves, technology may actually begin to bring medicine back into a more sane, human-centered way of working. As healthcare providers, we can usher that new way of working into reality — or we can resist it by holding tight to "the devil we know."  I suggest the latter.

Curious how a simple technology like iClickCare actually works? Watch a 1-minute video to learn more: 

Recently, seven major hospital systems put out a bold call.

It is crucial, they contend, to improve data sharing and interoperability among EMRs and EHRs. As Fierce Healthcare reports, "In a 2017 AHA survey, 57% of respondents had experienced challenges sending the proper information to a different vendor platform. And 37% ran into challenges just matching patient identities between systems."

Any healthcare provider who works with Electronic Medical Records won't dispute that data sharing is lacking with these tools. But despite the importance of this report, I see 3 crucial blindspots that it has -- and that your hospital may have, too.

I agree that interoperability among EMRs and EHRs is something that we should all demand. The simple access to data about your patient is as fundamental as having a clean and private exam room to see that patient in... or as having the ability to record your own notes about that patient. 

So I was glad to see this hospital report come out. That said, I believe there are three crucial shortcomings to this report. And identifying them isn't so much to undermine the findings or importance of the report itself -- but to identify blindspots that your hospital may have as it begins to pursue interoperability of EMRs and EHRs.

3 crucial shortcomings to focusing on EMR interoperability:

• EMRs / EHRs will never be true healthcare collaboration tools.
  No matter how sophisticated interoperability among medical records becomes, the truth is that these systems will never be true healthcare collaboration tools. The records simply aren't made to easily facilitate multidirectional care coordination and medical collaboration among all members of a care team. And so it's a mistake to believe that by solving interoperability, we might have improved care coordination or collaboration. 
• Providers need better tools now. 
  The reality is that even if EMRs and EHRs become more interoperable, healthcare providers need better communication and collaboration in the meantime. The reality is that today, EMRs and EHRs consistently get in the way of sharing data and patient information. Until the day that EMRs/EHRs are interoperable, healthcare providers must take the burden on themselves of making sure that other members of the care team have HIPPA-secure access to patient information. 
• We need collaboration among people, not computers. 
  The AHA report emphasized that "there is an urgent need to coalesce around improved standards that overcome the significant gaps making communication difficult between systems." In other words: we need our computers to communicate better. But the harder truth is that allowing computer systems to share data is just Step One. What is really needed in medicine is the ability of providers to collaborate and coordinate care. The data-sharing is just the foundation -- it doesn't necessarily facilitate the profound collaboration that needs to occur for good care to happen. 

As always, these organization-level initiatives -- like those to improve interoperability -- are crucial. They are long-term projects that affect key foundational aspects of what we do as providers. But these projects are often uni-dimensional and may not affect our work in the holistic ways we need them to. So even as hospital-level and nation-level work occurs, we as providers must create and demand tools that are immediate and holistic enough to support excellent care for our patients. 

There has been an increasing trend towards consolidation in the healthcare field. Hospital systems buy other hospital systems, with the promise of cost-savings, improved results, and better data-sharing and interoperability.

In many ways, this is common sense. If we’re all part of the same organization, or even under the same roof, it stands to reason that we will be able to share data and collaborate more effectively.

Unfortunately, though, this doesn’t appear to be the case.

Using data from the 2014 American Hospital Association (AHA) annual survey and the 2015 IT supplement that included more than 2,000 hospitals, researchers found that consolidation enough wasn’t enough to improve interoperability.

In fact, it took several additional circumstances for interoperability to improve: centralized organizational governance, a specific business model, and an integrated insurance offering. 

Of course, achieving interoperability and data sharing is a hugely complex endeavor that can take time to come to fruition. It's not a race, and there are many precautions and complications that arise.

That said, I find it fascinating that even merging with another organization doesn't necessarily make it more streamlined for healthcare providers to collaborate, for data sharing to happen, or for interoperability to be a reality. 

My take on why? I believe that true data sharing and healthcare collaboration only come about through intention and through workflow changes on the part of healthcare providers. Yes, the organizational structure affects it. Yes, EHR interoperability plays a role. Yes, being under the same roof can make collaboration simpler than being in separate buildings. But ultimately, healthcare collaboration comes down to the choices that individual healthcare providers make. It's the choice to ask a question of a colleague, regardless of how that question gets asked. 

That's why we're so passionate about hybrid store-and-forward telemedicine® (like iClickCare) as a tool for healthcare collaboration. It doesn't require being under the same roof, or in the same organization, or even using the same EMR/EHR to collaborate, share information, and coordinate. It doesn't require that everyone in your organization use it or that everyone is "on board."  It just requires a 30-second download and then as-you-have-time consults with colleagues. Everything is archived so you can find it later -- and it won't conflict with your EHR. 

The above study certainly demonstrates that we can't wait for large structural shifts to practice medicine in ways that we think are right, and useful. We have access to the tools and structures we need now -- it's just a matter of acting on that.

I'd like to start by saying that I have huge respect for the VA (of course). The work they do is deeply honorable, incredibly challenging, and skillful. Especially as we approach our Independence Day, I believe that the VA is a key part in protecting our nation. 

That said, they do face the challenges of being a large, underfunded government agency. And the scandals that have roiled the institution over the past few years reflect the challenges that so many organizations face, even if (slightly) less bulky and (a little) less underfunded. And the VA potentially reflects the same solutions that we all need to consider if we're to advance -- it's just starker in their case.

Exhibit 1: a year after the Department of Veterans Affairs was scandalized by long wait times (as well as falsifying wait times), the number of veterans on waiting lists of one month or more is now 50 percent higher than last year. Not for lack of trying, either. The VA has expanded care. Its doctors and nurses have handled 2.7 million more appointments, while authorizing 900,000 additional patients to see outside physicians. Physician workloads increased by 18-21% in most regions. And yet the department’s deputy secretary, Sloan D. Gibson said, "if we don’t do something different we’re going to be $2.7 billion short.”

Exhibit 2: the VA has developed an in-house system to allow caregivers to access their patients' records across the agency's facilities. (Something you would think would be a nonnegotiable for anyone providing medical care.) The VA is currently looking for an EHR for the system (an $11 billion bid) but it seems that most of the options won't be interoperable across the VA system. "I feel like we're in a thicket here and we can't get out," Sen. Bill Cassidy (R-La.) said. "We're about to spend $11 billion on a system that the VA's system is not interoperable with? Please tell me that I'm absolutely wrong."

The VA's challenges of interoperability, collaboration, and capacity are challenges we all have. And missteps may be impossible for them to avoid -- but that we probably can.

These are two key learnings from the VA to consider in the effort to find sustainable solutions:

1. You can't just make physicians work harder -- you have to find a way for the organization to work smarter.
   The fact that physicians output is up by around 20% over last year -- in an organization with infamously overworked providers -- is not a sustainable situation. As we saw last week, this kind of "optimization" is a recipe for burnout -- which is ultimately bad for the organization. Other initiatives, like this one to use telemedicine to decrease workloads -- are going to be a better path forward, even if they have less immediate rewards.
2. Enable healthcare collaboration, even if it is outside of your EMR or EHR. 
   Interoperability can be very challenging, especially with the existing EMR and EHR options. That said, if medical providers aren't able to share information and collaborate with each other, results and metrics will suffer. We've found that it is often better for an organization to use a collaboration platform (iClickCare is a telemedicine based one) to bridge the gap and collaborate even as EMRs and EHRs catch up with interoperability concerns.

We can root for the VA even as we learn from their mistakes. And if we're going to improve medicine in this country, we must do both. 

Hybrid store-and-forward telemedicine is a key solution for collaboration in organizaitons with limited resources. Learn more with our free guide:

My teachers in medical school and residency did not take kindly to me ordering extra tests for patients.

You don't order tests that you don't need, they would tell me. Because when you're not following a logical path, but just poking around for what might come up, you can end up with bad conclusions, bad results, and wasted resources.

However, a recent article in the New York Times reminded me that medical providers are "tricked", guided, and incentivized to order extra tests at every turn. Dr. Zuger looks at how, these days: "Guidelines mandate tests, and patients expect them; abnormal tests mean medication, and medication means more tests."

No one is tricking us, and yet the system can influence us to make decisions we might not otherwise make-- no one's fault but everyone's problem. 

A sure way to form a bond with any medical provider is to share "war stories" of your EMR / EHR. Whether a specialist or a generalist, and across the spectrum of care, providers struggle with the heavy burden that this technology has created. 

EMRs with poor user interfaces, no collaboration mechanism, and formats that force counterintuitive thinking are hugely detrimental to providing good patient care. They contribute to the shrinking time we have with each patient and, as the article explores, can contribute to making mistakes. 

Things get even worse when you look at the performance of most EMRs / EHRs in managed care system. When the hospital system or ACO is responsible for the full scope of performance and efficiency for each patient, the losses that bad tech causes become compounded. There is an ever-worsening shortage of providers; how can we rationalize even a 20 minutes loss in their time each day due to bad tech? 

So what are providers and administrators to do? Well, we certainly don't have all the answers, and we know first-hand how frustrating technology can be. But here are 4 things that our colleagues have found to make technology in medicine a blessing, rather than a curse: 

1. Invest in well-designed technology. Some products invest more in the design of the interface and functionality of the tool. Demand that the tool that helps you care for patients is elegant, easy to use, and helps you do your work in the ways you want to do it.
2. Change how you work. As Robert Wachter said in the New York Times recently: "In health care, changes in the way we organize our work will most likely be the key to improvement... It means creating new ways to build teamwork once doctors and nurses are no longer yoked to the nurse’s station by a single paper record. It means federal policies that promote the seamless sharing of data between different systems in different settings."
3. Figure out if there is just a lag time. The New York Times article above also mentioned what Erik Brynjolfsson, a management professor at M.I.T., described as “the productivity paradox” of information technology, in which there is a delay between adopting a new technology and experiencing the benefits from it. This is a reality to some extent, so patience can be helpful -- as long as you're not waiting for a gain that is never going to happen.
4. As we shared in this post, you are not setting yourself up for success if you make huge investments in hardware. We recommend investing in software (which can be updated, and is generally the lowest portion of costs) rather than hardware which gets obsolete quickly. Use the equipment you already have, the spaces already available to you, and just start. 

One way to deal with poor technology at work is by bringing the tools that work for you, on your own phone / device: Bring Your Own Device (BYOD.) The challenge here is whether you'll run afoul of HIPAA. Click below to learn easy ways to stay secure. 

In the past weeks, the Office of the National Coordinator of Health Information Technology (ONC) published an ambitious, lucid, and fairly comprehensive roadmap to IT interoperability across the country. It follows a 2014 commitment to interoperability and "proposes critical actions that the public and private sector need to take to advance the country towards an interoperable health IT ecosystem over the next 10 years."

The key components of the roadmap are:

• Establishing standards and "rules of engagement."
• Creating the conditions for good, safe, seamless sharing of electronic health information for “small” (individual patient), “big” (population level and beyond) and “long” data (wrapping around the individual and telling their health story over time).
• Motivating the use of those standards through appropriate incentives.
• Aligning states in policy, payment, and other levers.
• Making data more portable and transferrable.
• Creating a trusted environment for the collecting, sharing and using of electronic health information. 

Quite honestly, we're incredibly excited to see this kind of conversation happening at the governmental level. For so many years it seemed that the government was willfully ignoring health IT and telemedicine.

When managed care, care coordination, and PMPM payments are such big focuses, there must also be constructive conversation about IT interoperability.

To achieve this, however, the health IT community must expand its focus beyond institutional care delivery and health care providers, to a broad view of person-centered health. This shift is critical for at least two reasons:

1. Health care is being transformed to deliver care and services in a person-centered manner and is increasingly provided through community and home-based services that are less costly and more convenient for individuals and caregivers.
2. Most determinants of health status are social and are influenced by actions and encounters that occur outside traditional institutional health care delivery settings, such as in employment, retail, education and other settings.

This shift requires a high degree of information sharing between individuals, providers and organizations. It is vital that a high degree of interoperability exists between many different types of health IT, such that systems can exchange and use electronic health information without special effort on the part of the user.

The goal of this shift is to a nationwide learning health system—an environment that links the care delivery system with community and societal supports in "closed loops" of electronic health information flow, at many different levels, to enable continuous learning and improved health. This kind of system allows individuals to select platforms and apps to share and use their own electronic health information to meet their needs without undue constraints.

In other words, we need to remember that healthcare is about people. And people have human lives with human complexities that happen outside of institutional settings. To do coordinated care well, that's the reality of the context. And that's why we support medical collaboration that uses hybrid store-and-forward telemedicine® as a key part of health IT. It's the most efficient path to keeping the patient at the center of the technology -- and allowing interoperability to emerge from that center point.

If you're curious how health IT and telemedicine can actually contribute to that kind of person-centered approach, watch our 60-second primer:

Image courtesy of automania on Flickr, used under Creative Commons rights.