The electronic health record is a powerful tool for today’s clinicians. It can provide access to current information in multiple locations at once, it can help avoid errors and duplication in service, and it can make care more convenient and timely for patients. But it has required, and continues to demand, changes in how doctors and other clinical workers provide care.
Listen as Ryan Gossett, MD explains how Aspirus is leveraging this important and powerful new technology to benefit our patients.
Your Electronic Health Record (EHR): How Does It Impact Patient Care?
Featured Speaker:
Learn more about Ryan Gossett, MD
Ryan Gossett, MD
Ryan Gossett, MD is the Chief Medical Information Officer, Aspirus Inc.Learn more about Ryan Gossett, MD
Transcription:
Your Electronic Health Record (EHR): How Does It Impact Patient Care?
Melanie Cole (Host): The electronic health record is a powerful tool for today's clinicians. It can provide access to current information in multiple locations at once; it can help avoid errors and duplication in service; and it can make care more convenient and timely for patients. My guest today is Dr. Ryan Gossett. He's the Chief Medical Information Officer at Aspirus, Inc. Welcome to the show, Dr. Gossett. Start by telling us about the importance of e-health records in today's society.
Dr. Ryan Gossett (Guest): Well, thanks for having me. You know, I think that over the last decade, really, as the use of electronic health records have really pervaded the industry. It's really changed the way that doctors are able to aggregate information around their patients and their patient's care. Historically, with the paper charts, it was a lot of chart tracking, faxing, and trying to get information around what had been previously going on with a patient sitting in front of them and that led to a lot of problems where there wasn't a complete set of information and so, potentially, a decision couldn't be completely evaluated before it was made or testing was re-done in order to try to fulfill or fill out that understanding before a decision was made. Now, as electronic health records have become more commonplace across the industry, it's allowing providers to get a robust set of information around their patients as they're sitting in front of them and really trying to provide the best care for that patient at that time.
Melanie: Dr. Gossett, we've all had the experience of having to hand carry our files from one provider to the next. What's involved in actually setting up electronic health records?
Dr. Gossett: Well, I think that you know, the carrying of records presents a little bit of an issue that I'll get into in a moment, but really setting them up is really trying to—initially, it was trying to recreate the paper in an electronic world, and what we've come to realize is that really electronifying or moving to an electronic record really changes the way that we need to think about the delivery of care. And so, it's not only a technical process of setting up servers and networks and all of the infrastructure that lays underneath these, but it's also re-evaluating the way that we go about our care processes and changing those to more better improve the way we utilize the electronic health record. A challenge, on the flip side, is that moving the information has, in some ways, gotten a little bit harder, you know? It used to be, to your point, you used to grab a file folder and start aggregating your own information, and you can do that still today with print outs on some of these electronic health records, but really moving your record around is really where the industry is trying to focus itself so that it's much easier as a patient to kind of move about rather than feel like your data is stuck in one particular health system's record system.
Melanie: Does somebody have to physically type in the records from a patient to get this all changed over? What's involved as far as all of the semantics of it?
Dr. Gossett: I think it's a variable answer. You know, again, as we've been moving down the road of getting these systems to talk to each other, information is moving more so without the need for each and every person to enter their independent group of information. So, things like your medication list and your problem list and some of your records are now moving a little bit more seamlessly than they used to. Previously, it was a lot of manual data entry each time you went to a new health system in order to get your information in to them, but that's slowly improving and so the amount of burden, I guess, from a clerical standpoint on the healthcare team is slowly getting better as well.
Melanie: So, tell us about the Aspirus Epic system and how you're getting that initiated.
Dr. Gossett: We've actually been on Epic since 2004. So, we're a little over a decade into our adventure with electronic health record. We have continued to grow as a health system and so that has meant that we continue to grow where we're utilizing our Epic platform. So, while it was initially a couple handfuls of clinics and one hospital, we've really now grown to a little over 60 clinics and seven hospitals that are utilizing the same Epic platform. So, it's been growing the system to keep up with the system group so that when our patients are moving around our system, we have that continuity of information so that the care can be provided most effectively.
Melanie: And how is this going to benefit the patients? Will they be able to have better access to their records and history?
Dr. Gossett: Yes. Another component of the electronic health records in Epic is--one of many--is that they all have a patient portal that allows the patients to get access to their own information, generally over a web browser. So, you can log in to your record and see components of your record. Things like your medication lists, you can ask for refills, you can review results and lab information. So, it does provide a layer of transparency to the patients as they're also trying to help drive their care, as well.
Melanie: And what about privacy? Have any patients expressed an interest in the privacy issue or a concern?
Dr. Gossett: I think some have. You know, I think that was a bigger concern as the electronic health records were kind of up-and-coming. There was a lot of concern about security of the information and I think that remains an issue across the board, not only in electronic health records, but we hear about information being stolen or credit card information, you know, electronic security across the spectrum remains a concern, I think, for everybody involved. We have quite a bit of security work that gets done not only locally at the Aspirus system, but I know Epic Corporate takes the information and the security around the information quite seriously. And so, we work diligently every day to maintain that level of security while also trying to allow not only the care providers, but as we just talked about, the patients, relatively easy access to their information to continue to help drive their care.
Melanie: And, what about for the providers? Is this going to make it so even if they're in a different hospital system that this information is standard across the board?
Dr. Gossett: I think that's where the industry is moving to. And so, again, there are multiple different platforms that health systems are sitting on, Epic being one of them. Cerner is another large one, and so historically, they did not do a great job of communicating with each other. That's really where a lot of the development is being focused right now. Because we are seeing challenges with patients moving across town or across the country, either that or for a short period of time on vacation or even long-term, and getting access to that information has been challenging in the past. That is improving, again, not only in the way that the information is being shared and pushed around, but also getting outside access to providers and care providers into the record more efficiently. So, while I would say that's not an ideal state, I think that is probably where most all of the research efforts really are being focused on. How do we do that more effectively so that we can have that singular record concept more so for the patient and the patient's care?
Melanie: Has workforce training been a challenge as far as the electronic health records?
Dr. Gossett: I think that's an evolution. You know, a lot of the more seasoned care providers grew up in a paper world and didn't really spend much time, whether that be in their training or even in their professional career, interacting much with technology and computers. As that group has been kind of the leading edge of the e-chart deployment over the last decade, training has really been a significant component of the deployment and also supporting them over their care process timelines. As the younger generation is now becoming part of the workforce, they've really grown up, you know, technology has been at their side really since they were toddlers, and so adopting to it really isn't an adoption, it's just an extension of their normalcy. So, training and support for the younger set or the "millennials" I guess, so to speak, has been a different sort of set of support than for the more seasoned providers.
Melanie: And are there certain limitations with e-health records, Dr. Gossett? What about something, for example, advanced care planning, or advanced directives? Are these involved as well?
Dr. Gossett: They are, and I would say, to a degree, it makes that easier. Again, while, historically, most patients would take their advanced care plans or their advanced directive type documentation to their primary care provider who would tuck it in a file folder in their little file storage room for safekeeping and the patient would keep one, now we essentially digitize that information. We scan it and we can link it into the patient's record so that, again, while they're moving about the health system, it's accessible. It's not hiding in a file folder at one, specific, physical location, but that also becomes accessible more easily to care providers in other systems when they're looking for information. So, there are some benefits to the access--there remain limitations. There remain some frustrations around how well that information is moving about. Again, historically, grab a page, fax it, and the provider on the other end would have the information they're looking for. That is a little more complicated. The amount of information, at times, is overwhelming to some of the care providers. While there is easy access to the information, now that, for example, we've been up for a decade plus, there's a lot of information that sits in one, singular place that at times, is causing frustrations for providers. They’re really starting to weed through reams of information where they historically, in their own offices, decided what was and wasn't living within their record.
Melanie: What happens to all the paper records as the conversion to electronic health records becomes a reality?
Dr. Gossett: Well, the amount of paper that is generated within our own system has dramatically reduced, but there remains some paper coming in and out of the system and I would say we still have some of our processes still exist on paper. For the most part, we try to get that into the system, again, by scanning and digitizing that information so that it is now kept electronically, rather than in paper format. Partially, so that it is accessible for the care providers, but partially for its long-term storage, rather than having to physically store papers in file rooms, we're now storing information as bits and bytes on servers in racks in storage facilities in our data centers.
Melanie: So, wrap it up for us, Dr. Gossett, if you would, about electronic health records and what you want the Aspirus community to know about this initiative with Aspirus.
Dr. Gossett: I would say that the electronic health record is really here to help us work on and improve the care processes that we're going about to take the best care for our patients. The electronic health records, as an industry, is relatively young, and as they continue to improve their platforms, the way that they are able to help us in our care process will only continue to get better. So, we certainly are not at the end of this journey. We are very much at the beginning of it, but things will only continue to improve as time goes by.
Melanie: Thank you so much for being with us today. It's really great information. You're listening to Aspirus Health Talk and for more information, you can go to www.aspirus.org. That's www.aspirus.org. This is Melanie Cole. Thanks so much for listening.
Your Electronic Health Record (EHR): How Does It Impact Patient Care?
Melanie Cole (Host): The electronic health record is a powerful tool for today's clinicians. It can provide access to current information in multiple locations at once; it can help avoid errors and duplication in service; and it can make care more convenient and timely for patients. My guest today is Dr. Ryan Gossett. He's the Chief Medical Information Officer at Aspirus, Inc. Welcome to the show, Dr. Gossett. Start by telling us about the importance of e-health records in today's society.
Dr. Ryan Gossett (Guest): Well, thanks for having me. You know, I think that over the last decade, really, as the use of electronic health records have really pervaded the industry. It's really changed the way that doctors are able to aggregate information around their patients and their patient's care. Historically, with the paper charts, it was a lot of chart tracking, faxing, and trying to get information around what had been previously going on with a patient sitting in front of them and that led to a lot of problems where there wasn't a complete set of information and so, potentially, a decision couldn't be completely evaluated before it was made or testing was re-done in order to try to fulfill or fill out that understanding before a decision was made. Now, as electronic health records have become more commonplace across the industry, it's allowing providers to get a robust set of information around their patients as they're sitting in front of them and really trying to provide the best care for that patient at that time.
Melanie: Dr. Gossett, we've all had the experience of having to hand carry our files from one provider to the next. What's involved in actually setting up electronic health records?
Dr. Gossett: Well, I think that you know, the carrying of records presents a little bit of an issue that I'll get into in a moment, but really setting them up is really trying to—initially, it was trying to recreate the paper in an electronic world, and what we've come to realize is that really electronifying or moving to an electronic record really changes the way that we need to think about the delivery of care. And so, it's not only a technical process of setting up servers and networks and all of the infrastructure that lays underneath these, but it's also re-evaluating the way that we go about our care processes and changing those to more better improve the way we utilize the electronic health record. A challenge, on the flip side, is that moving the information has, in some ways, gotten a little bit harder, you know? It used to be, to your point, you used to grab a file folder and start aggregating your own information, and you can do that still today with print outs on some of these electronic health records, but really moving your record around is really where the industry is trying to focus itself so that it's much easier as a patient to kind of move about rather than feel like your data is stuck in one particular health system's record system.
Melanie: Does somebody have to physically type in the records from a patient to get this all changed over? What's involved as far as all of the semantics of it?
Dr. Gossett: I think it's a variable answer. You know, again, as we've been moving down the road of getting these systems to talk to each other, information is moving more so without the need for each and every person to enter their independent group of information. So, things like your medication list and your problem list and some of your records are now moving a little bit more seamlessly than they used to. Previously, it was a lot of manual data entry each time you went to a new health system in order to get your information in to them, but that's slowly improving and so the amount of burden, I guess, from a clerical standpoint on the healthcare team is slowly getting better as well.
Melanie: So, tell us about the Aspirus Epic system and how you're getting that initiated.
Dr. Gossett: We've actually been on Epic since 2004. So, we're a little over a decade into our adventure with electronic health record. We have continued to grow as a health system and so that has meant that we continue to grow where we're utilizing our Epic platform. So, while it was initially a couple handfuls of clinics and one hospital, we've really now grown to a little over 60 clinics and seven hospitals that are utilizing the same Epic platform. So, it's been growing the system to keep up with the system group so that when our patients are moving around our system, we have that continuity of information so that the care can be provided most effectively.
Melanie: And how is this going to benefit the patients? Will they be able to have better access to their records and history?
Dr. Gossett: Yes. Another component of the electronic health records in Epic is--one of many--is that they all have a patient portal that allows the patients to get access to their own information, generally over a web browser. So, you can log in to your record and see components of your record. Things like your medication lists, you can ask for refills, you can review results and lab information. So, it does provide a layer of transparency to the patients as they're also trying to help drive their care, as well.
Melanie: And what about privacy? Have any patients expressed an interest in the privacy issue or a concern?
Dr. Gossett: I think some have. You know, I think that was a bigger concern as the electronic health records were kind of up-and-coming. There was a lot of concern about security of the information and I think that remains an issue across the board, not only in electronic health records, but we hear about information being stolen or credit card information, you know, electronic security across the spectrum remains a concern, I think, for everybody involved. We have quite a bit of security work that gets done not only locally at the Aspirus system, but I know Epic Corporate takes the information and the security around the information quite seriously. And so, we work diligently every day to maintain that level of security while also trying to allow not only the care providers, but as we just talked about, the patients, relatively easy access to their information to continue to help drive their care.
Melanie: And, what about for the providers? Is this going to make it so even if they're in a different hospital system that this information is standard across the board?
Dr. Gossett: I think that's where the industry is moving to. And so, again, there are multiple different platforms that health systems are sitting on, Epic being one of them. Cerner is another large one, and so historically, they did not do a great job of communicating with each other. That's really where a lot of the development is being focused right now. Because we are seeing challenges with patients moving across town or across the country, either that or for a short period of time on vacation or even long-term, and getting access to that information has been challenging in the past. That is improving, again, not only in the way that the information is being shared and pushed around, but also getting outside access to providers and care providers into the record more efficiently. So, while I would say that's not an ideal state, I think that is probably where most all of the research efforts really are being focused on. How do we do that more effectively so that we can have that singular record concept more so for the patient and the patient's care?
Melanie: Has workforce training been a challenge as far as the electronic health records?
Dr. Gossett: I think that's an evolution. You know, a lot of the more seasoned care providers grew up in a paper world and didn't really spend much time, whether that be in their training or even in their professional career, interacting much with technology and computers. As that group has been kind of the leading edge of the e-chart deployment over the last decade, training has really been a significant component of the deployment and also supporting them over their care process timelines. As the younger generation is now becoming part of the workforce, they've really grown up, you know, technology has been at their side really since they were toddlers, and so adopting to it really isn't an adoption, it's just an extension of their normalcy. So, training and support for the younger set or the "millennials" I guess, so to speak, has been a different sort of set of support than for the more seasoned providers.
Melanie: And are there certain limitations with e-health records, Dr. Gossett? What about something, for example, advanced care planning, or advanced directives? Are these involved as well?
Dr. Gossett: They are, and I would say, to a degree, it makes that easier. Again, while, historically, most patients would take their advanced care plans or their advanced directive type documentation to their primary care provider who would tuck it in a file folder in their little file storage room for safekeeping and the patient would keep one, now we essentially digitize that information. We scan it and we can link it into the patient's record so that, again, while they're moving about the health system, it's accessible. It's not hiding in a file folder at one, specific, physical location, but that also becomes accessible more easily to care providers in other systems when they're looking for information. So, there are some benefits to the access--there remain limitations. There remain some frustrations around how well that information is moving about. Again, historically, grab a page, fax it, and the provider on the other end would have the information they're looking for. That is a little more complicated. The amount of information, at times, is overwhelming to some of the care providers. While there is easy access to the information, now that, for example, we've been up for a decade plus, there's a lot of information that sits in one, singular place that at times, is causing frustrations for providers. They’re really starting to weed through reams of information where they historically, in their own offices, decided what was and wasn't living within their record.
Melanie: What happens to all the paper records as the conversion to electronic health records becomes a reality?
Dr. Gossett: Well, the amount of paper that is generated within our own system has dramatically reduced, but there remains some paper coming in and out of the system and I would say we still have some of our processes still exist on paper. For the most part, we try to get that into the system, again, by scanning and digitizing that information so that it is now kept electronically, rather than in paper format. Partially, so that it is accessible for the care providers, but partially for its long-term storage, rather than having to physically store papers in file rooms, we're now storing information as bits and bytes on servers in racks in storage facilities in our data centers.
Melanie: So, wrap it up for us, Dr. Gossett, if you would, about electronic health records and what you want the Aspirus community to know about this initiative with Aspirus.
Dr. Gossett: I would say that the electronic health record is really here to help us work on and improve the care processes that we're going about to take the best care for our patients. The electronic health records, as an industry, is relatively young, and as they continue to improve their platforms, the way that they are able to help us in our care process will only continue to get better. So, we certainly are not at the end of this journey. We are very much at the beginning of it, but things will only continue to improve as time goes by.
Melanie: Thank you so much for being with us today. It's really great information. You're listening to Aspirus Health Talk and for more information, you can go to www.aspirus.org. That's www.aspirus.org. This is Melanie Cole. Thanks so much for listening.