Transcending Digital Documentation: The Evolving Role of Electronic Health Records
Q&A with Craig Limoli, Founder and CEO of Wellsheet
Electronic health records (EHRs) were initially developed to store digital versions of medical records and facilitate billing. Over time, their use has evolved, driven by technological advancements, regulatory changes, and shifts in care delivery models. In this post, I’ll review several emerging trends that set the stage for the future role of EHRs. Then I’ll share a Q&A with Craig Limoli, a former student in our Wharton MBA Course, who is now the Founder and CEO of Wellsheet, an innovative company that is leveraging the app ecosystem within EHRs to transform health care.
Emerging Trends
From Record Keeping to Managing Care
Before: Initially, EHRs were primarily used for digital record-keeping, replacing paper files to store patient medical histories, diagnoses, medications, treatment plans, and test results.
Now: EHRs serve as comprehensive care management tools that support decision-making, predictive analytics, and personalized medicine. They integrate a wide range of data, including genomic information and social determinants of health, to provide a more holistic view of a patient’s health.
Increased Patient Engagement and Access
Before: Patient interaction with EHRs was limited, mostly through indirect means like requesting printouts of medical records.
Now: There has been a significant shift towards patient-centered care, with patients gaining direct access to their health information through patient portals and mobile apps. This empowers patients to actively participate in their care, schedule appointments, communicate with healthcare providers, and monitor their health data.
Shift to the Cloud
Before: EHR systems were predominantly hosted on-premises, requiring substantial IT infrastructure and resources.
Now: The shift towards cloud-based EHR solutions has made these systems more accessible, scalable, and cost-effective. Cloud hosting facilitates easier updates, enhances data storage capabilities, and improves data sharing and interoperability.
App Ecosystems
Before: EHRs were similar to early cellphones with all its functionality loaded onto the device in the beginning with limited options for adding new capabilities.
Now: Many EHRs have robust App Stores similar to smartphone app stores. Health systems can add new capabilities by integrating these new apps through standard approaches that link to EHR data. This change provides opportunities for innovations beyond what the EHR vendors themselves create. Check out the Q&A that follows below for an example.
Integration of Artificial Intelligence and Machine Learning
Before: EHR systems were once static repositories of information with limited capabilities for data analysis.
Now: Modern EHRs incorporate AI and machine learning algorithms to analyze health data for predictive analytics and improve diagnostic accuracy. Increasingly these approaches are being used to help streamline documentation and facilitate clincial decision support.
Expansion of Telehealth and Remote Monitoring
Before: Telehealth and remote patient monitoring were relatively underutilized, often due to technological and regulatory barriers.
Now: The integration of telehealth functionalities and remote monitoring tools within EHRs has expanded rapidly, accelerated by the COVID-19 pandemic. This shift allows for real-time monitoring of patients' health status, virtual consultations, and better management of chronic conditions outside traditional healthcare settings.
Q&A with Craig Limoli, Founder and CEO of Wellsheet
Tell us about your background and journey before and after business school
I founded Wellsheet after working at IBM as a strategy consultant in their Watson Health division, where I led business development for their flagship care coordination product. After seeing the deficiencies in existing technologies in healthcare, I saw an opportunity to leverage AI and a new API-based integration model in the healthcare industry to create a better experience for physicians. After meeting visionary mentors like John Glaser, now on Wellsheet’s Board, and Mitesh Patel himself, I left the Wharton MBA program in 2016 to start Wellsheet. Since then, Wellsheet has become the industry leading Smart EHR UI solution, transforming the EHR experience for some of the largest health systems in the country.
Can you tell us the story behind how Wellsheet started and what was your big break?
In my consulting career at IBM, there was a stark contrast between the severity of the technology challenges that clinicians faced and other industries like retail and transportation. It struck me as unjust that clinicians, representing arguably the most important function in our society, were stuck with some of the most backwards and inefficient technology, and I felt compelled to create a better solution for them.
We initially started developing the technology in small clinics, but our first big break came when we deployed to our first hospital in 2018, Newark Beth Israel Medical Center, in Newark, NJ. After a very successful pilot, RWJBarnabas Health, the largest employer and healthcare provider in New Jersey decided to expand Wellsheet across all 7 of their Cerner hospitals, which led to rapid growth in adoption and utilization of the product across thousands of physicians across the health system. Now, Wellsheet is going through an unprecedented phase of growth and being deployed across hundreds of hospitals nationally.
What is Smart UI and how did the field develop within EHRs?
A Smart UI (User Interface) is a technology that brings intelligence and other functionality on top of an existing infrastructure layer through a more modern and efficient frontend for users. The need for a Smart UI often arises in regulated, complex problem spaces, where delivering a great user experience takes a back seat to meeting regulatory requirements. EHRs certainly fit this bill, which has been a recognized need in the industry for a long time, and many technologies have been brought to market in attempt to address this need. However, doing so in a scalable, well-integrated way only became possible with the advent of API standards that have emerged only in the past several years. FHIR (short for Fast Healthcare Interoperability Resources) is the prime example of these new standards. Gartner created the Smart EHR UI category based on the impact that technologies like Wellsheet were having for health systems, which has now been featured in multiple Hype Cycle reports, such as the ability to:
Increase clinician productivity and capacity by reducing time spent on chart review and searching for relevant clinical data
Improve the total experience of patients and clinicians by maximizing the patient-clinician interaction, whether conducted virtually or in-person
Enable clinicians to make more informed decisions and reduce errors of omission by elevating relevant data that might otherwise be overlooked.
What can you do within an EHR app environment that you can’t do as easily within the native EHR?
Wellsheet is loved by clinicians for its user-friendly design and the speed that it brings to their workflows by predicting what matters most to a particular clinician treating a particular patient. Instead of needing to click through many different screens across the EHR, Wellsheet brings all of that data to the user in a single view. Wellsheet also enables easier care team collaboration so that the attendings, residents, and nursing staff are all on the same page about the care that patients need, as well as real-time notifications for new results instead of needing to keep checking the chart for new data. In fact, Wellsheet encompasses so many aspects of clinical workflow, that health systems have been able to replace a number of other point solutions with a single enterprise deployment of Wellsheet.
Further, unlike the major EHR systems that were developed decades ago, Wellsheet is built as a modern web application, representing a major advancement in architecture that brings marked advantages in stability, scalability, and ease of upgrades. For example, EHRs require substantial investments by health systems for every update to their systems which only happen twice a year, at best; Wellsheet, on the other hand, is deployed in less than 8 weeks across a health system and can be updated weekly without any intervention or maintenance required by the health system. This shift has led to an exponential decrease in cost for bringing new innovations to clinicians.
Can you share any feedback from health systems or frontline clinicians?
In Wellsheet’s NYC offices, there is a “wall of gratitude” with messages from clinicians who have reached out to us to express their appreciation for Wellsheet. Doctors call Wellsheet “life-altering” for their workflow and tell us that it easily saves them more than half of their chart review time. Some have even pointed out times that Wellsheet has helped save patient lives by highlighting data that led to critical interventions for patients. This feedback is what motivates us as a company, and surveys consistently show major increases in satisfaction with the EHR experience after Wellsheet is implemented. Wellsheet’s industry-leading adoption and engagement rates also demonstrate how satisfied clinicians are with the product. Unlike the EHR, which clinicians have no choice but to use, Wellsheet use is optional, so every interaction with the product is a vote over the legacy EHR workflows.
Where do you see EHRs apps headed in the future and what’s the path ahead for Wellsheet?
We envision a future where clinicians interact with modern and flexible EHR apps instead of the EHR itself; where clinicians have a say in what tools they use to deliver care to patients, like other industries; and, consequently, where clinicians are able to do what called them to be in healthcare to begin with, spending time with patients and ensuring they have the best care possible.
Wellsheet has been using AI for years, including the patented machine learning models that predict what content to highlight in what clinical contexts, but the advent of generative AI (GenAI) has opened exciting new doors to drive more efficiencies into clinical workflow, so we are focused on rapidly delivering those benefits to our users. Already, Large Language Models have enabled clinicians to auto-generate content in Wellsheet for their handoff notes based on data from the EHR to accelerate the informal notes shared among care teams that drive patient care. Wellsheet is also developing GenAI functionality that summarizes key content by patient condition, aligned to the contextual clinical views at the core of the way Wellsheet displays clinical data. With an unprecedented emphasis on clinician efficiency, a novel API-based integration model, and groundbreaking advancements in AI that unlock features that were previously inconceivable, there has never been a more exciting time to be building in healthcare.
Interested in learning more about Wellsheet? Register for an upcoming Webinar on March 7th