Paul Dolan, MD, chief medical information officer at Benefis Health System in Great Falls, Mont., discusses his hopes for the future innovation of the EHR and the apps and technologies he's found most helpful.
Responses have been lightly edited for clarity and length.
Question: How do you feel about the use of voice recognition technology, such as Amazon’s “Alexa” and Google Assistant, in healthcare? Is there a place for its use within the EHR?
Dr. Paul Dolan: When referring to a voice recognition assistant helping a provider navigate within an EHR, as opposed to voice recognition transcription, my first reaction was that I didn't think I saw a place for it, but the more I have thought about it I do see a potential for it going forward. I can foresee a provider asking for a risk calculation to be performed, an order set to be pulled up, or asking for what test — based on the input of the patient's current history, symptoms, exam and testing — is best to rule out a certain condition based on pretest probability. That would involve the intersection of the voice activated assistant, the medical record and an artificial intelligence platform. 'Alexa, what is the current differential diagnosis and based on the patient's genetic profile and testing thus far, what is the next test indicated?'
Relative to voice recognition technology in the generation of a visit note, we are on the cusp of dramatic changes. It is anticipated that a system will listen to the conversation between a patient and provider and after a provider has answered some key questions, the system will generate a note capturing the encounter. That will be a game changer if, in particular, the notes generated paint a clear picture of the patient history and exam.
Q: Which apps and technologies do you find most helpful, and which do you think will be passing fads?
PD: I find the following apps and technologies most helpful:
1. The improved voice recognition software has really proven to be of benefit to many of our providers.
2. The encrypted text communication app we utilize for communication between staff and providers now is a huge step forward from the days of trying to just page or call providers.
3. The online references imbedded in the medical records and available to providers is proving to be invaluable. The one we utilize the most is also accessible through an app on the phone.
4. Many of our providers utilize an app that provides numerous formulas and calculations for various disease states.
As for passing fads, to some extent, I think it is more that the current iteration of some apps and technology will be passing fads. Things evolve. There will be more AI-driven applications for both providers and patients. I'm hopeful that our EHR will rely less on structured data that tries to boil complex issues down to an ICD-10 code name choice but will retain the richness of the patient story so that important nuances will not be lost. That is more my dream for the future than a description of a passing fad.
Q: How has your role as CMIO evolved over the past two to three years? How have your responsibilities changed since you took on the role?
PD: Two to three years ago, we were spending a lot of effort in making the decision to select a new EHR as we have disparate systems in the inpatient and outpatient arena. At that time, I was spending a substantial amount of time outlining the advantages and disadvantages of the potential selections in addition to attempting to project their capability of meeting future needs. In the end, due to the dark clouds on the financial horizon relative to reimbursement, we made the decision to forgo a new integrated EHR and work to optimize our current platforms. It isn't so much a shift in responsibilities as a shift in focus. We are playing catch up to some degree as we had put off a substantial amount of changes that we thought would be incorporated in the new EHR implementation.
My role is balanced between that of the CMIO in addition to working as one of three who are working in the office of the chief medical officer. I handle things that pertain to the hospital medical staff relative to credentialing, governance, etc. As such I play a role in quality, patient safety, utilization and review, compliance and [health information management].
Q: What do you consider your No. 1 priority as CMIO? How do you ensure you're successful?
PD: My No. 1 priority is to try and make utilizing the EHR as functional, efficient and effective for the clinicians as possible. The usability of the current EHRs is improving, but there is still a long way to go. Additionally, the format of record fostered by [evaluation and management] coding requirements in addition to meaningful use measures has resulted in the medical record becoming data rich, but information poor. It is often hard to read a note and understand what truly transpired with a patient.
To ensure I'm successful, I need to listen to and advocate for the clinicians while balancing the capabilities of the system coupled with the requirements for billing, coding, etc.
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