Penn Medicine has an ambitious new plan to transform EHRs into more streamlined, interactive, smarter tools that ease the work of clinicians, expedite care, and drive the best possible patient outcomes. By prioritizing the needs of providers, who are increasingly burdened by the demands of data entry, they are reimaging these tools as not merely documentation systems, but as an element of care delivery itself.

HealthCare Business News spoke to Dr. David Asch, executive director of the Penn Medicine Center for Health Care Innovation, to learn more about the initiative and its goals.

HCB News: You and your team at Penn Medicine are setting out to improve the way physicians relate to the EHR. What can you tell us about your own background with health records and what led to this initiative?
Dr. David Asch: Most members of our team are clinicians, and that’s critical. But members of the team also have three other essential skills, including software development, design, and behavior change. And pretty much everyone has at least three of those four.

The clinical sensibilities are so critical because we are ultimately solving for the best patient outcomes. And often the best way to solve for patient outcomes is to develop tools that are effective for clinicians. If you are in the business of making scalpels, you want those scalpels to be useful to the surgeons who are operating on patients. If you are in the business of building electronic medical record systems, you want those systems to be useful to clinicians caring for patients.

Right now, the clinicians are complaining that contemporary EHRs are not so useful. We think they can get better with skills from clinical medicine, software development, design, and behavior change.

HCB News: It seems paradoxical that EHRs would present new challenges to workflow when we're so accustomed to technology making our lives simpler. Why are medical records an exception?
DA: Technology certainly has that opportunity to simplify – it comes down to what it was designed to accomplish. Early EHR development focused on meeting administrative standards for documentation and billing. The unrealized value still awaits as far as designing technology that can now also enable clinical care to be more frictionless, informed, and coordinated.

HCB News: To what extent are the problems with EHRs provider based, as opposed to vendor/software based?
DA: The answer is of course both, but I will take sides here for emphasis. The problem is vendor/software based. Yes, clinicians – like all humans – are reluctant to change. But better designed software would have been designed around them in the first place so they wouldn’t have to change much. There are close to a million physicians in the U.S. alone and just a handful of software vendors. Wouldn’t it make more sense to move the software rather than the physicians?

HCB News: Can you tell us about the progress you're making with reimagining EHRs?
DA: Well, we’ve done a lot better at reimagining EHRs than turning those dreams into reality. This is hard work. But current EHRs are not the products of imagination. They are the products of taking what we already had and digitizing it. The EHR knows to flag a certain hemoglobin level as abnormal, but not to compare it against historic values for that patient, check the mean corpuscular volume, reticulocyte count, and offer suggested next steps. Nor can the EHR automate. It cannot tell me that a patient I was worried about missed her last lab test and cancelled their office appointment, or better yet reach out to the patient to ask why.

HCB News: In the future, how might a physician’s interaction with the EHR be different than it is now?
DA: Much less of it! Hopefully the EHR becomes an extension operating in the background – a functional and cognitive relief in care delivery. The perfect EHR would be like my mitochondria: busily working in the background, but I don’t have to think about them. I rarely think about my mitochondria, but I am glad they are there.