What If Apple Reimagined The Electronic Health Record?

Chief Strategy Officer at ClearDATA, providing comprehensive cybersecurity solutions to make healthcare work better every single day.

Thirty-six billion dollars and over a decade later, the HITECH Act signed by President Obama to motivate the implementation of electronic health records (EHR) in the U.S. created some unintended consequences. The goal of increasing EHR adoption by physicians, whether it be in the hospital, ambulatory or medical practice settings that they work in, has largely been achieved, with nearly 90% adoption across these settings. The goal of moving from paper records to digitizing the medical record by physician documentation of the patient encounter through the EHR is another return on this investment. 

Additionally, physicians use EHRs to order billions of dollars of laboratory tests, diagnostic imaging exams and medications for their patients every year. The EHR is streamlining these processes for both patients and clinicians, as well as allowing for closed-loop integration of the results back into the EHR to create a holistic picture of a patient's visit. One could argue that EHRs created the digital foundation and that Covid was a catalyst for the aggressive adoption of digital health applications today, including virtual care, patient apps, remote monitoring devices and more.

The Challenge: Physician Burnout

However, despite the progress in EHR adoption, there has been a serious negative, unintended consequence from using an EHR: physician burnout. Several academic studies analyzed the phenomenon and one study by the Mayo Clinic concluded that physicians now spend one to two hours on EHRs and desk work for every hour spent in direct face-to-face contact with patients, as well as an additional one to two hours of personal time on EHR-related activities outside of office hours. The study evaluated the usability of current EHR systems and concluded that there is a strong relationship between EHR usability and higher odds of burnout — current EHR systems received a grade of “F” by physician users when evaluated using a standardized metric of technology usability.

The American Medical Association stated, "It is a national imperative to overhaul the design and use of EHRs and reframe the technology to focus primarily on its most critical function — helping physicians care for their patients." Current EHR systems are not designed to prioritize time with patients, rather they overload physicians with onerous type-and-click tasks, alerts and redundant documentation requirements. 

Three Apple-Inspired Design Imperatives To Improve EHR Adoption

Many would agree that Apple is the world’s preeminent company when it comes to designing consumer tech and could likely help solve the problem of EHR adoption. What if Apple reimagined the EHR and designed something physicians loved and were easier to use? A reimagined EHR may lie in three areas where they are leaders: voice recognition technology, machine learning and artificial intelligence (ML/AI) and consumer engagement and privacy management. 

Leveraging Voice To Automate Low-Value tasks

A major drawback of the current EHR design is click-fatigue. This is where voice assistants like Siri could play a role in automating some of the necessary but lower-value tasks, whether that be navigating the medical chart record, ordering laboratory tests and diagnostic exams, retrieving historical documents embedded in the chart, etc. These are likely not the basic version of the voice assistants we have today in Siri, but rather upgraded ones, taking into consideration the nuances of the electronic health record, its templates, technical architecture and the ecosystem services they are increasingly being connected to. 

Using ML/AI To “Listen” To The Patient-Physician Conversation

Documentation of the patient visit is a key function of the EHR and is a major contributing factor to physician dissatisfaction with EHRs. Leveraging ML/AI tech to develop an ambient listening tool that captures the patient-provider conversation and takes intuitive action such as transcribing the doctor’s note in the EHR and cueing up a care plan for the patient. Further, appropriately designed ML/AI can use deductive reasoning to draw conclusions based on these “clinical conversations” and then offer up intelligent documentation that the physician would then review and sign off on. 

Integrating The Patient Into The EHR Workflow With Privacy And Managed Consent

Perhaps the most innovative way to improve EHR usability is to integrate the patient into the clinical workflow — an area where Apple’s consumer tech experience shines. Automating and integrating the myriad of important data and tasks like data streaming from consumer medical devices, pre-visit data collection, electronic appointment booking, post-visit care plan dissemination, secure messaging with physicians and follow-up to assist in managing chronic conditions can be integrated into the EHR and a “health hub” created for the patient. Apple’s health kit and its integration into several U.S. healthcare delivery organizations set the foundation for this. Making this connectivity bi-directional and ensuring privacy and consent is managed appropriately for secure cloud sharing aligned with HIPPA, GDPR and other regulatory frameworks will be key. 

Conclusion

In hindsight, the HITECH Act did not take usability into consideration and how important it is to connect all these systems that healthcare invested billions of dollars into. Consumer tech companies, like Apple, that have highly adopted products and have built platform businesses provide many lessons in reimagining healthcare technology and connecting the siloed healthcare system, especially when it comes to the EHR, which is so foundational to the individuals who take care of our health every day.

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