Kenny Walter

 to read more from HCPLive's "Sudden Future" feature series. 

If you ask 10 doctors about their electronic health record (EHR) system, you might get 10 answers as to why they are a problem.

The one constant, however, would be that there are problems. And few things are stressed more by users than that the devices, designed to help streamline clinical data logging and access, take up valuable time and ultimately contribute to physician burnout.

A group of physicians from the Saint Louis University School of Medicine have taken the matter of realizing the streamline aspirations of EHR platforms to task: they created the means to have their institution-used system automatically populate necessary forms, reducing the time spent searching through the record system endlessly for the right set of notes.

Alexis McKee, MD, Endocrinology Diabetes & Metabolism, Internal Medicine, Chris Sallie, MD, Hospitalist, Pediatrics, Pediatrics, and Mark Eddy, MD, Pediatric Endocrinology, Pediatrics, explained in an interview with HCPLive® how tweaking their EHR system they were able to achieve big success.



The basis of the Saint Louis model is that the researchers are taking advantage of what the EHR already knows. To start, it knows the patient’s age and why they are visiting the doctor; this alone provides the doctor with all the appropriate forms needed automatically without a lengthy search through the system.

One of the main EHR complaints that McKee and Sallie have heard from their colleagues is that they are required to find the note name themselves.

“So, we tried to eliminate a lot of those steps to say, ‘I'm just going to bring you the appropriate thing for you to fill this out,’” Sallie said.

This stressor grew more apparent in March, as the coronavirus disease 2019 (COVID-19) pandemic began to ramp up, pushing many medical appointments to a virtual setting.

With the switch to telemedicine, doctors across the country were forced to use brand new forms when filing records following an appointment.

However, the EHR used by McKee’s group automatically populated the necessary consent and other forms needed for a telehealth visit.

Sallee explained how it took less than an hour to initially implement the new setting into the system, ultimately saving each doctor time on the backend.

The platform used by Missouri-based physicians is provided by Epic, provider of record-keeping systems for more than 50% of doctors across the country.

The doctors are using a program offered by Epic called Physician Builder, which allows providers to become amateur program developers to specify what they need to streamline their individual practices.

“What Chris, Mark, and I have learned to do, by going up and taking these Physician Builders courses is to manipulate the health record to work exactly the way we want it to work,” McKee said. “So, it's this intersection between tech, medicine, academic science, all coming together to improve quality of care and efficiency.”

What made the team’s use of this free application on the most popular EHR system in the country stand out, though, is its adoption in treating what was very recently the greatest public health concern in the US.

The Saint Louis doctors are now able to use their platform in alignment with the most recent guidelines and clinical research from the American Diabetes Association (ADA).

“If your patient has diabetes and heart failure you should be looking at an SGLT2 inhibitor unless they have contract indications X, Y, and Z,” McKee said. “And then that could just populate without doing anything.”

Implementing data-driven programs is not always easy, though.

“I think the problem is that diabetes is just a data-dense subspecialty,” Eddy said. “Trying to get the information into a node that we can bill and get our work done is a difficult endeavor with sort of the system that we have.”

While the system has had an impact on patient care, the doctors do have plans to upgrade the platform. Ultimately, they’d like to implement a “plug and play” model that would automatically upgrade the EHR’s data as new information is released by the ADA and other medical associations.

Even without the automatic updates, the new EHR has had an impact on Sallee’s clinic.

The endocrinologist said his clinic saw 10,700 patients in 2010 prior to implementing the streamlines platform. That number skyrocketed last year to more than 23,000 patients, without any significant increases in providers or space.

And yet, the time from when the patient signs in to when the notes are completed decreased by 91%.

The burnout problem could be alleviated by utilizing new technology to improve EHRs.

“Because if you have some stake in the game, you have some control over doing things, you're always going to feel better,” McKee said. “The definition of stress having no control over your environment. So, when you have this like terrible EHR, that you're spending your nights filling in this like crappy way. It's definitely frustrating.”

Whereas, he countered, if a physician felt as if they had more control over the EHR, it becomes the tool they always envisioned it to be. Burnout becomes benefit.


While the constant updates to guidelines and new clinical trials are daunting for medical professionals to learn, they make it nearly impossible for patients to learn about their treatments and conditions.

However, much like a streamlined EHR can aid doctors in improving patient care, online learning tools can help patients navigate text and clinical jargon and become better informed about treatment options.

Match Health Academy recently created a new set of online classes aimed at improving patient knowledge. In an interview with 

, Kavita Bouknight, founder and chief executive officer of Match Health Academy, explained the basis for the new health classes.

“It's essentially an online learning platform, which helps consumers better understand their health conditions, or that of loved ones,” she said. “And especially if you have little to no background in medicine, navigating through text and reading clinical lingo can really be overwhelming and often confusing.”

The new courses include comprehensive video courses where consumers can “take control” of their condition by using a combination of 3D animations and visual analogies to help break down more complex concepts to help make it easier to understand.

The program also includes all the different type of treatment options available for each patient.

Each video course is between 25-35 video modules with each module no more than 2 minutes long on average.

Bouknight said the project was in the works prior to the COVID-19 pandemic, but the developers sped up the project once the pandemic began. They also included a larger focus on respiratory conditions, with the first courses focusing on asthma, COPD, and sleep apnea.

The videos could aid doctors as well as patients.

“A lot of times not all physicians are going to be aware of all of the different treatment options depending on their specialty. And so, what we do is that we curate the different types of medical innovations that are available for a particular condition,” Bouknight said.

One of the reasons the new platform is necessary is there has been major advancements in medical research in recent years with more and more treatment options becoming available. With that said, the majority of the long-standing older treatments still can be effective for patients.

Along with pharmacological options, this platform also includes new technologies that come to market that could help treat various disease. For example, recently there has been a few sleep apnea technologies made available that go beyond CPAP machines.

“There's new advancements happening every day,” Bouknight said. “And that's the purpose of one of the purposes of our platform is to give consumers everything they need to know in one place, because it's incredibly difficult as a consumer to even know what to look for.”

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Sudden Future: Streamlined EHR Could Help Drive Better Patient Care

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In an analysis that was scheduled to be presented at ENDO 2020, investigators examined a phase 2 and phase 3 clinical trial of the insulin-like growth factor 1 receptor inhibitory monoclonal antibody, indicated teprotumumab was effective across multiple subgroups of patients across the 24-week trials.
	
	In January, the US Food and Drug Administration (FDA) approved teprotumumab as the only treatment for TED.

From the pair of 24-week randomized, double-masked, placebo-controlled, parallel-group clinical trials, investigators identified a total of 171 patients with active TED associated with Graves’ disease.

The study eye was designated at baseline manifested more severe TED and a clinical score of more than 4. Investigators segmented patients into subgroups based on gender, smoking status and age at baseline. The primary outcomes of the study was the percentage of proptosis responders and proptosis change from baseline.

In an interview with HCPLive®, Raymond Douglas, MD, PhD, director of the Orbital and Thyroid Eye Disease Center at the Cedars-Sinai Medical Center, explained the importance of the teprotumumab in treating this patient group and how the coronavirus disease 2019 (COVID-19) might impact thyroid eye disease patients.

New research shows teprotumumab can be a beneficial treatment for patients suffering from thyroid eye disease (TED), even across age, gender and risk factor-based subgroups. In an interview with HCPLive®, Raymond Douglas, MD, PhD, director of the Orbital and Thyroid Eye Disease Center at the Cedars-Sinai Medical Center, explained the importance of the teprotumumab in treating this patient group and how the coronavirus disease 2019 (COVID-19) might impact thyroid eye disease patients.

Author | Kenny Walter

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Sudden Future: Streamlined EHR Could Help Drive Better Patient Care

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