​What if physicians could "subscribe" to their patients, the way we subscribe to online "feeds" about our favorite sports teams, stock quotes, or news alerts? What if physicians could receive relevant clinical information from their patients' electronic health records (EHRs) at the time the information is most needed, rather than having to passively access the system at a random opportunity in the day's busy schedule? Writing in the May 24, 2018, issue of the New England Journal of Medicine, a team of authors at an academic medical center asked, "What would it be like to instead subscribe to Ms. Jones in room 328?" Noting that most EHRS are still mainly "digital remakes" of their paper predecessors, just as the first movies were little more than plays captured on film, the authors developed a web application that pulls patient information in real time from the health system's multiple digital sources and alerts clinicians to the information most relevant to their own patients exactly when the information is actionable. The authors piloted a test of the system that sends alerts for medications that need refilling; the effort cut missed doses of antibiotics and antiepileptic medications by a third. Clinicians can also receive text reminders for patients who need interventions on a particular schedule, or real-time notification when a patient on mechanical ventilation may be ready for a test to breathe without assistance, or care summaries when a patient is set to be discharged, allowing them to follow up on time. Most systems are still "built around passive engagement with a medical record," the authors note, with healthcare organizations functioning on the hope that the physician will "get to the chart on time." Physicians would be unlikely to set every patient on their "feed," the authors say; the advantage of the system is allowing customization for particular patients with particular needs. The authors note that systems allowing the physician to "subscribe to the patient" must still be designed to minimize alert fatigue.

HRC Recommends: Use of EHRs expanded significantly after the government began offering financial incentives to providers to implement and use EHR systems in a meaningful way. Current regulations require use of certified EHR technology to earn payments under the Medicare and Medicaid EHR incentive programs. Risk managers can help healthcare organizations seek out best practices and resources for EHR implementation and ensure that the organization conducts due diligence in selecting an EHR vendor. When transitioning from one EHR vendor to another, organizations should examine electronic documentation functionalities that may reduce error rates and improve patient care. Risk managers should also understand the EHR documentation workflow to ensure that it does not create undue burdens on providers that are likely to result in the risk-laden behavior of workarounds. Involve clinicians from various specialties in the EHR vendor selection process, in reviewing proposed clinical templates, and in integrating the EHR into clinical workflows and testing processes. Obtain legal review of contracts with EHR vendors, and ensure that EHRs meet federal regulatory criteria for meaningful use. Analyze adverse event and near-miss reports related to EHRs, and provide feedback.