Katie the Intern 1/1/21

Happy Holidays, HIStalk! I hope you had a great Christmas and are set to have a happy and safe New Year. This column offered a wide range of topics that I found really informational and interesting, so I’ll touch on a few of them and go more in-depth on some in the next column. Hope you enjoy! 

This time around, I spoke with Rodrigo Martinez, MD, a practicing otolaryngologist who describes himself as being “familiar with the gaps between many of the good ideas and technologies that are employed and why they often fail when implemented into the clinical environment.” I thought this would be an excellent intersection to discuss healthcare IT, as Dr. Martinez has experience in medicine, EHR strategy and consulting, and software implementation. 

Dr. Martinez serves as the chief clinical officer at TransformativeMed, a company that builds software for specialty-specific data visualization that embeds inside an EHR. TransformativeMed has worked inside Cerner and is moving into Epic in early 2021. Dr. Martinez’s start as a physician gave him an insight into the importance of incorporating physician-based ideas into EHR implementation to solve macro-level issues. 

“I have had an interest in how you take all of these different technologies and how you bring them into a clinical workflow,” he said. “In parallel, as you have more and more technologies that are consumer-focused, how do you create processes and workflows that stitch all of these different capabilities together?”

To create a workflow to start this process, a provider needs to have an EHR in place that can begin this implementation of different technologies. I realized I have not really asked past interviewees about that process, so Dr. Martinez spoke to this topic and how it has changed over time. 

A decade ago, a provider would start with an overhaul of processes and select an EHR that could best support them, Dr. Martinez said. The push for the use of these electronic healthcare records by government began in 2009, and rewards were given to those companies that selected EHRs that met Meaningful Use criteria. 

“What that did was create an enormous rush to implement electronic health records,” Dr. Martinez said. “That’s why you have seen, over the last 10 years, such a dramatic increase in the adoption– or at the very least, implementation — of electronic health records.”

Today, EHR concerns center on how a facility can maintain the best access to data. Access to data and the use of EHRs to manage that task are incredibly important because of CMS incentives and repercussions. In sheer numbers, an estimated 97% of hospitals nationwide used EHR data in 2017, compared to 87% in 2015. This jump in usage means that health systems can no longer afford to use just any EHR, but need a system that can manage data from multiple sources. 

“You’re seeing health systems go after a single EHR system in an attempt to try to maintain the cleanest flow of data,” Dr. Martinez said. “Once a patient starts to move in and out of one system or another, you lose the ability to quickly and cleanly access and move data, or you’re forcing the end-users, the physician or the nurse, to jump into and out of different systems.” 

Though so many clinics and providers have EHRs in place, Dr. Martinez said many of these EHRs are not well adapted and do not provide the benefit that vendors originally promised. This is where his intersection of ideas comes into play, and where TransformativeMed embeds solutions that improve clinical collaboration across inpatient care teams. 

Closing the gap between what an EHR can do and what an EHR does for a provider group is an important task to Dr. Martinez. Some of the tools that his company creates has begun to do just that. The specialty-specific views of data, called the Core Clinical Workflows, allows a provider to gather specific patient and specialty information without sorting through the clutter of multiple specialties. 

“Usually, the EHRs are set up with fairly generic-looking displays of data,” Dr. Martinez said. “We have pre-optimized or curated ways of looking at the information so that there is less hunting around for information, so you’re increasing the workflow efficiency.”

This data is available on desktop and mobile devices, as well as in app form for some specific decision-support tools. The software also allows for easier patient handoff and task management. This fingertip access supplies an easier and faster process for providers who are focusing on patient health decisions. 

The app that Dr. Martinez specifically spoke about was the Core Diabetes App, a tool for inpatient diabetes management. The backbone of a clinical support tool is reliant upon information about a patient’s state in an illness (in this case, diabetes). This app focuses on a single disease state, Dr. Martinez said, and combines all of a patient’s data in real time for up-to-date information that can impact decisions around care.

“The software is reading all of the vital signs and the glucose and blood pressures and a bunch of other elements, and it combines all of that information and it presents it in a very easily digestible and actionable format,” Dr. Martinez said. “The end user can standardize those protocols and can scale them across the entire health system. That is a huge step in driving evidence-based care for diabetes.”

If a clinician is able to see all of the combined information in real time, they are better able to make a decision about care. Providers are always able to act on the most recent evidence and information. This app is targeted at monitoring and managing diabetes, but what about other diseases?

Dr. Martinez said that many diseases can be monitored in similar fashion to diabetes, watching and managing those high and low levels and keeping a patient within them. For example, alcohol withdrawal, the regulation and management of blood thinners, and even pain management are all illnesses that could be managed or monitored through a similar system. It comes down to working with individual health systems on what they need to monitor the most.

“There are a number of things and we have really been exploring what are some of the other conditions that hospitals and health systems are prioritizing,” Dr. Martinez said. “Then, by partnering with them, we co-develop these different capabilities.”

Dr. Martinez and I also covered the idea of AI powered assistants and their application, which I believe I will focus on for the next column.

I am enjoying learning about the tech side of integration in these manners, and I’d love to write and research more about them for future columns. So that is it for this one!

Happy New Year! I cannot be the only one to say that I am excited to send 2020 off with a bang!

Katie The Intern

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