Leveraging Seamless Workflows in Medical Documentation

Joshua Lenchus is an accomplished physician executive with humble beginnings. From community college to C-suite, Dr. Lenchus has always been driven to effect change. Involvement in numerous professional medical organizations has culminated in various leadership roles. His interests, skills and experience include healthcare public policy, public speaking, media commentary, medico-legal reviews/expert witness, performance of bedside invasive procedures, simulation, hospital medicine, opioids, medical education and patient safety. His background includes education, teaching, clinical, administrative and research work. Truly a well-rounded physician, in his effort to "pay it forward," he has served as mentor to scores of others across many specialties and fields of work.

1. What are some of the major challenges and trends that have been impacting the MedTech space lately?

The electronic medical record (EMR) utilization still causes a fair amount of consternation. Some still fight it altogether and long to return to the days of transcribed dictations and paper records, and some have embraced the technological advances and utilize the system as much as they can. While the vast majority have simply resigned themselves to satisfying the requirement without being shy when conveying their displeasure about the relative lack of clinical usefulness identified in notes due to note bloat, copy and paste issues, regulatory documentation requirements, and poor accuracy of voice recognition software, I do not see any of those issues abating anytime soon and, in fact, note the literature that supports EMR integration as a source of burnout.

I have seen a trend in leveraging the EMR in documenting social determinants of health (SDoH). While I fully submit that these non-medical factors have a significant impact on patient care, especially in the post-acute phase, I am frustrated that we healthcare professionals identify these obstacles but have little to no power in addressing them. Rather, health systems that can work with their communities in mitigating these factors would likely demonstrate a healthier, or perhaps more adherent, population.

2. What keeps you up at night when it comes to some of the major predicaments in the MedTech space?

Privacy, interoperability, clinically appropriate and useful documentation, security, workflow impediments, and clinical decision support systems come to mind immediately. Generally, I believe that technology should mirror efficient workflow rather than adjusting workflow to integrate technology. Ultimately, I believe in an EMR so long as the information contained therein is an accurate clinical description of the patient’s care rendered throughout the encounter. I was pleased to hear that our documentation may be moving to focus on more medical decision-making rather than simply making an assessment to check a box for documentation requirements in support of coding and billing.

“Generally, I believe that technology should mirror efficient workflow rather than adjusting workflow to integrate technology”

3. Can you tell us about the latest project that you have been working on and what are some of the technological and process elements that you leveraged to make the project successful?

We use Cerner for our EMR and have recently transitioned to dynamic documentation and speech-to-text technology for dictating notes while maintaining the option of typing them. It was a long and arduous process to do this across the system but I am pleased to say that it is now complete. The next step is to improve the accuracy of the dictations and implement a real-time clinical decision support component so the specificity and acuity of what is documented can appropriately improve and properly reflect our case-mix index.

4. Which are some of the technological trends which excite you for the future of MedTech space?

I am most excited about the possibilities surrounding artificial intelligence integration, telehealth platforms, mobile personalized electronic health information, virtual reality, and personalized mobile applications and their ability to interact with other technological platforms.

5. How can budding and evolving companies reach you for suggestions to streamline their business?

I am happy to speak with them. In fact, I think more collaboration is integral to ensuring success.