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Optimizing HIT to Prepare for the Next Patient Surge

By Christopher Maiona, MD, SFHM

The merits of preparation have been espoused for centuries. From Confucius (“Success depends upon previous preparation, and without such preparation there is sure to be failure”) to Alexander Graham Bell (“Before anything else, preparation is the key to success”).

No doubt, great minds and leaders across the ages have recognized the importance of getting ready for whatever may come next. And when undertaking such preparations, it is vital to account for obstacles that are right under one’s nose. (As Gandalf says in J.R.R. Tolkien’s The Hobbit, “It does not do to leave a live dragon out of your calculation, if you live near him.”)

In health care in 2020, we have met the dragon, and its name is COVID-19. It is vital that we prepare well to effectively meet the demands of the next patient surge, whether it’s related to the COVID-19 pandemic (very likely) or some other medical crisis (inevitable). And part of preparation includes ensuring a hospital’s HIT infrastructure is not just up to par, but anticipates the needs of a stressed system.

As telehealth becomes the norm for much outpatient care, population health issues make national headlines daily, and public health officials are the new rock stars, it is clear that health systems must hit the gas on certain mission-critical IT initiatives.

From a hospital IT perspective, perhaps the most glaring functional gap revealed by the pandemic relates to care team members’ inability to access patient records and each other at a moment’s notice, anytime, anywhere.

To that end, nothing could be more practical or timely amid the COVID-19 surge than enabling patient data access and care team collaboration capabilities on mobile devices. Smartphones and tablets are the information access and communication tools of choice for most clinicians, wherever they may be—within the hospital, in a triage tent, quarantined at home, or anywhere in between. (It stands to reason that using secure mobile devices makes more sense than installing a dozen hard-wired terminals in a temporary facility in the hospital parking lot!)

The Move to Mobile

But for hospitals under the gun in the midst of this pandemic, is implementing such mobile functionality really feasible?

In fact, it’s a fairly light lift, especially when compared with the move from paper to electronic patient records—think of those systems as “EHR 1.0”—that many hospitals undertook 10 years ago. Today, we live in a mobile-centric world in which the use of apps, with their intuitive swipe-and-tap interfaces, is second nature to most people. That was not the case when medical records first migrated from paper to EHR systems, nor would anyone have called the typical EHR 1.0 interface “intuitive.” Rather, most EHRs simply replicated the paper-based workflow and page design on a computer screen. EHRs recreated the paper chart digitally right down to the fish bones that physicians used as a form of shorthand to document certain lab results.

Still, the move to mobile represents an adjustment for EHR 1.0 users, if only because change brings at least some measure of the unfamiliar. But this change promises to solve at least one major problem: We’ll finally put the computer to its best use, as a tool that makes physicians better and more efficient clinicians, rather than treating it as an electronic piece of paper.

Advancing system interoperability also will be a key to the emergence of next-generation (“EHR 2.0”) systems in all their potential richness and functionality, not only from a mobility perspective. Whatever “system of engagement” (device or interface) a clinician uses to interact with the hospital’s system of record (EHR) and other departmental systems, all relevant clinical data must be available in one place, formatted and presented consistently, in order for clinical care to be delivered in a manner that makes sense to each individual provider. As health information exchanges grow, and more health care apps (both for patients and providers) are built using SMART on FHIR and other advanced development technologies, practical interoperability will move from the realm of aspiration to reality.

The value of “mobilizing” the hospital EHR goes far beyond effectively caring for patients under crisis conditions. It has become essential for provider collaboration on patient care generally, as physicians today are as “siloed” as patient records once were. We are not all in the same hospital at the same time. Remote access to records and the ability to easily communicate with each other within the context of a patient chart are key to the kind of collaboration that fosters better care.

Mobility also has been demonstrated to be a significant facilitator for telemedicine. If it wasn’t for the initial work in simplifying the EHR on a mobile platform, the rapid scale-up of telemedicine during the COVID-19 crisis might not have been possible. In addition, mobility affords providers an opportunity to limit unnecessary personal exposure beyond patient encounters by removing them from common spaces and shared equipment. Following a patient encounter, a provider may review records and document the visit away from the nurse’s station, on their own tablet or phone.

The future is mobile. It’s definitely where health care is headed. If writer Elbert Hubbard was indeed correct when he said, “The best preparation for good work tomorrow is to do good work today,” then provider organizations can and must prepare now for the next patient surge by implementing a mobile HIT infrastructure that affords ready and actionable access for clinicians to relevant patient data. Because mobility will be vital to delivering quality care the next time your hospital is under strain.

— Christopher Maiona, MD, SFHM, is chief medical officer of PatientKeeper, Inc.