Originally published: April 15, 2014 on MedTech Boston.

Interview with Dr. Adam Landman, Officer for Health Information, Innovation, and Integration at Brigham and Women’s Hospital


We followed up with Dr. Adam Landman, an emergency physician CMIO for Health Information, Innovation and Integration at BWH and a speaker at the recent panel, to talk more about challenges and solutions in healthcare. He shared his thoughts on “meaningful use” compliance, disruptive technology and innovation taking place at Brigham and Women’s Hospital.

What are some of the biggest challenges that physicians face in their practice today?

There are obviously a lot of challenges, and I also look at them as opportunities. The first is transitioning from a fee-for-service system to a value-based reimbursement system. This is a big change for physicians, and they need more support and tools to help them perform in the new value-based system.

Second is the increasing number of administrative tasks and complexity of health care. It’s really taking away from the time physicians can spend with the patient. We need to find ways to allow physicians to do what they do best, which is caring for the patient.

The third challenge is that right now, there are a lot of mandates, and it compounds the first two challenges. For instance, a lot of practices across the country are devoting their resources to comply with “meaningful use.” It can be hard to respond to those mandates and at the same time try to become more efficient in your practice, reduce the cost of care, and improve quality.

What inefficiencies do you think can be solved by technology, and how can they be solved without perpetuating the problem of doctor-patient alienation?

We really need to understand how technology can be best used with the patient. Technology can be used to help engage the patient and improve the physician-patient relationship. For instance, if the physician shares some results (such as an X-ray) with the patient by using the computer in the room, that can help engage the patient and help them understand why there’s a computer there.  Wearable technology is exciting and has tremendous potential to improve care; however, we need to be careful with new technology such as Google Glass and we really need to understand how those new technologies will impact or influence the physician-patient relationship. We need to move forward cautiously, and we need some research to better understand this area. Brigham researchers are starting to use Google Glass in a research setting to better understand its impact.  We are looking forward to showcasing some of these projects at the upcoming MedTech Boston Google Glass Challenge. In particular, we’re excited that nephrology fellowKarandeep Singh, MD, will be presenting on the expert panel.

In addition to technology, there are some policy levers that can be changed, largely reimbursement policies and requirements. If those are also altered, that can reduce the time physicians spend on administrative tasks. There may be policy and technology solutions to some of these issues.

How can the current electronic health record (EHR) system be improved or even supplemented?

Number one is just good usability design. A lot of people complain that many EHRs require a lot of clicks to achieve a particular action, and it might be an action you do many times a day. If every time you enter the patient’s physical exams, it’s 20 clicks, and you’re seeing 20 patients in an eight hour shift, that’s a lot of clicks just for the physical exam. Applying general good usability practices throughout the electronic health record could include creative use of colors, hover-overs, or pop-ups to make the experience most efficient for the user. It’s a challenge—many of these systems were built many years ago, and maybe on technology that might not have as much flexibility with usability. I understand the limitations, but there’s also room for improvement.

Another area that might be ripe for some disruption is search capability. Right now, most EHRs have pretty rudimentary search capabilities, if any at all. It can sometimes be very difficult to find what you’re looking for. Imagine trying to go through a paper record to find something. With some EHRs it’s almost the same, where you have to open many documents to find what you’re looking for.

We need better ways to search, and also better ways to summarize the EHR; right now we rely on providers manually maintaining problem lists and medication lists, and if we find ways to automate that and automate it with accurate data, that will improve the usability of the EHR.

Are you currently using technologies that can improve the use of the current EHR system?

We are currently using dictation and voice recognition technology in some areas of the hospital. In dictation, the provider dictates their note into a phone; the note usually gets transcribed (a combination of automated and manual methods), and then electronically placed into the patient’s record in the EHR. Once the dictation arrives there, the provider needs to review the note correct anything, and sign off on it.

We have a smaller number of areas of the hospital that are using voice recognition. Our emergency department is one of them. Voice recognition technology allows you to start talking, and in real time, the software transcribes what you’re saying and allows you to correct it. It takes some time to get used to, but I do use it regularly and so do a number of my colleagues, and many of us really like it. It allows us to provide the rich details, especially for histories and assessments, that are hard to get if you’re checking off boxes or if you’re typing.

Read the rest of the interview here on the site MedTech Boston.