Penn Medicine is using digital subscriptions to better manage the frequency and quality of the patient data doctors can receive from an electronic medical records system.

Consumers sign up and use digital subscriptions daily to read newspapers, view content on Netflix and for a host of other reasons.

Now, a big Pennsylvania medical center is using the concept of digital subscriptions and mobile apps to expedite how doctors and nurses access electronic health records and improve patient quality of care.

Today, more than 90% of the nearly 6,000 U.S. hospitals have an electronic health records system. But electronic medical records generate “reactive” vs. “proactive” use by providers, says Katherine Choi, a physician and clinical innovation manager for the Acceleration Lab at the Penn Medicine Center for Health Care Innovation in Philadelphia.

“Current EHRs are largely digital remakes of traditional systems, just as many early motion pictures were merely plays captured on celluloid and in time movies began using on-location settings and special effects to make the two-dimensional screen deeper than the three-dimensional stage,” Choi writes in a  recent article for The New England Journal of Medicine. “As compared with other digital transformations that have redefined the way we consume information, the effect of EHRs on clinicians’ engagement seems limited and effortful.”

Electronic health record systems are big repositories for patient data. Health systems and vendors also have developed portals and apps that enable providers, consumers and other designated users to access and update patient information. But electronic health records systems are built and managed in ways that often prevent data from being sent from the medical records system to doctors in ways that are useful, she says. “Physicians in the hospital can keep up with feeds on the Philadelphia Eagles, Taylor Swift and the price of Bitcoin without consulting a newspaper, yet they must still go to the chart to check on their patients,” Choi says.

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We’ve been treating the electronic health record as a communal trough of information that we all have to sift through when we don’t do that in any other part of our lives.

At Penn Medicine, Choi is leading a group of researchers using digital subscriptions to better manage the frequency and quality of the patient data doctors can receive from an electronic medical records system. For example, necessary medications were not reordered in 10% of cases because a Penn Medicine physician didn’t check a patient chart in time or didn’t notice the need for renewal, Choi says. To alleviate the problem, researchers developed an app and a service physicians, especially residents, can sign up for to receive text messages that contain updates on patient prescription deadlines and when those prescriptions need to be renewed.

“The result was speeding up the rate of prescription renewals by one-third,” Choi says.  “The transformative change was eliminating the need to be in the chart to know that a task had been overlooked in the first place,” she says.

Penn Medicine also developed a dashboard and text message program that providers could subscribe to that sent text alerts about patients who require the most care for both in and out of the hospital. A pilot project involved 30 very sick patients, charted the care they needed and created a care plan designed around their stay in the hospital and at home.

Now, all care for in the hospital and at home is coordinated with the patient’s medical record and vital metrics, such as hospital stays, prescriptions and renewal dates, while follow-up office or home visits are monitored on the dashboard. When a patient status has changed, or there is an upcoming home or office visit, all providers are automatically sent a text alert.

“After one year of use of this system, 30-day readmissions and total hospital days had decreased by 67% and 56%, respectively,” Choi says. “Subscription services help erode the distinction in follow-up care between inpatients and outpatients, focusing on what patients need rather than on where they are.”

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Text notifications sent using a HIPAA-compliant messaging platform also can shorten the lag time between when information becomes available and when it’s used.

An older approach at Penn waited until morning rounds were over to evaluate whether patients on ventilators in the intensive care units could breathe without assistance. Now, digital information has both enabled patients to be automatically evaluated and clinicians to receive prompts to act when patients meet the readiness criteria.

As an example, the new process has reduced delays so patients spend, on average, half a day less on ventilators.

“When I read the newspaper—which I do in its digital form—the top stories are pushed to me without me going to find them,” says Yevgeniy Gitelman, a doctor and a clinical informatics manager at the Center for Health Care Innovation.  “Yet, we’ve been treating the electronic health record as a communal trough of information that we all have to sift through when we don’t do that in any other part of our lives.”

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