ICYMI: Dr. Caesar Djavaherian’s Quora Session Recap
Carbon Health’s founding physician and Medical Director Dr. Caesar Djavaherian hosted a Quora session on AI, EHRs, provider burnout and more. We’re recapping the event by featuring the most upvoted questions from the community.
What are some of the challenges of making electronic health records more integrated?
There are many challenges in making electronic health records more integrated, including endless customization, vendor market share protection, health system market share protection, and technological factors. These are just some of the challenges of making EHRs more integrated. I’ll focus on the customization issue.
Currently, if you are a health system running an instance of the leading enterprise EHR systems and across the street is a different health system using the same EHR vendor as you, the two systems would not directly communicate with each other because they have been customized to such an extent that the data elements would not directly match up. So a patient who is seen at their doctor’s office running Cerner, Epic or Allscripts may show up at a competing hospital’s emergency department who has the same software, but their discrete granular data from their doctor’s office would not appear in the other hospital’s records. The best we have done with interoperability is getting one system to send a pdf version of the patient data to the other system to view, which is essentially a modern version of the fax machine.
A question that commonly arises from the patient perspective is, “Why did it take an act of congress to force electronic health record vendors to integrate their technology with each other?” Like most technology products, the more information that flows from one to the other, the more both sides would have access to better data about their users. We see that happen when websites allow you to login with Amazon or Google. But in the healthcare world, where data sharing amongst providers is arguably the most important realm, the established EHR vendors decided to set their own information exchange platforms rather than coming up with an industry standard for sharing granular data. The backdrop is that the legacy EHR vendors have been in a battle for market share and keeping their customers hostage in their ecosystem means that they cannot switch away from their software without significant barriers and concerns about lost data. Under the Affordable Care Act, vendors were forced to open their data to exchanges and common communication languages such as FHIR. This bold step has created an incredible opportunity for innovation to come to healthcare data that can be shared rather than siloed.
Driven by a vision of providing better care, faster, Caesar co-founded Direct Urgent Care, a technology-enabled urgent care network serving the SF Bay Area. With the merger in 2018, he now focuses on clinic innovation and providing data-driven, accessible care to each and every Carbon Health patient.
What does the future hold for electronic health records?
At Carbon Health, we tried to re-imagine what an EHR was for. Rather than just trying to put something that was done more efficiently on paper onto a computer screen, we asked ourselves: what would the best patient and doctor experience be? And would technology play a role in that experience? This fundamental question led to what we believe is the future of electronic health records. We realize that technology should be injected sparingly but smartly to make the workflows of each member of the team more efficient and always with an eye on informing patients about their care. So, we created an EHR that didn’t just replace the pen and paper that doctors used to use, but one that allows care teams to communicate with one another as easily as they do on their favorite apps. We created an EHR that allows patients and doctors to connect before and after a visit. Like the Carbon Health EHR, I believe the role of EHRs in the future will be to make the job of being a doctor easier through machine learning and other evolving technologies. It will also make the position of a patient more bearable with the EHR as a portal into the care that they received rather than a barrier.
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