Interviews from Healthcare’s Frontlines: Dr. Stephen Breneman

Posted June 19, 2017
By Corey Dahl

With access to more healthcare data than ever before, medicine is at a pivotal moment in its history. Redox is fortunate to have a front row seat to watch as innovative solutions redefine technology’s role in healthcare, and with us, our network is on the forefront of this new wave of digital technology adoption, too.

In this series, we interview physicians and other clinicians for their perspective on what innovations they’d like to see adopted, the new tech they’re excited to use, and general insight into the current state of the industry. They are, after all, on the front lines of patient care and have first-hand knowledge about the impact of medical technology—and they know better than anyone else what tools could help them and their patients.

Kicking off the series, we interviewed Dr. Stephen Breneman, an anesthesiologist at the University of Rochester Medical Center. As a practicing anesthesiologist who also trains his peers and works as a liaison to IT, he is well-informed about the practical applications of EHRs and technology adoption.

Because of his background, Dr. Brenemen has a uniquely valuable perspective on the state of healthcare. Read on for some of Dr. Breneman’s ideas for future clinical innovations (though some are likely not to be so distant).

Tell me about your digital health technology wishlist. If you had a magic wand to create any technologies as part of your workflow today, what would they be?

Rapid biometric identification after touching the computer. The amount of time physicians spend logging in and out of computers during the day is unbelievable. Even when logged in, physicians often still have to document their name several more times. In an ideal world, a computer would be able to identify who was touching it.

I would also like to see how big data and AI work together to present the information that is actually needed in the medical record. EMR adoption—while it has done a lot of positive things and I think is positive overall—also created problems with note bloat and too much irrelevant data. AI and deep learning systems should be able to distinguish what is irrelevant vs. pertinent, and then be able to pull out what is pertinent.

I’d love to be able to set my phone down and turn it into a virtual computer with a virtual screen and keyboard so I can work from anywhere. Maybe something like Google Glass. Sometimes people may make arguments against technology like this when thinking about HIPAA, but physicians could find a quiet room to work in at the hospital. Right now, I have to compete with many other clinicians for a computer. So much is done on mobile these days, I’d like to see things continue to move in that direction and allow for more flexibility of where and when you work.

Customization of viewing info on the record is another tool I’d love to utilize. For example, if I always want blood pressure on the left of my screen, I should be able to click and move the elements around in the way I want to see things when I’m working with the information.

Taking this a bit further, if you had a magic wand to create any healthcare or wellness technology for patients to use, what would it be?

I would create a patient-editable medical record that can be verified by a clinician. Patients receive care all over, and because of that, there are often holes in the chart. I’d like patients to be able to enter missing info and be an active contributor to their record.

In today’s world, what seems to be the biggest priority in healthcare?

I see lots of cost cutting by using more and more administrators to control physicians. We went from something like four administrators for every physician to sixteen to one now. Unfortunately, they are not there for the clinicians as individuals—they are there to make lots of clinicians safer.

We should focus on seeing the physician as a partner and a collaborator with the patient.

What else should be prioritized in addition to facilitating and supporting patient and physician collaboration?

We have self-driving cars. I believe deep learning systems and AI have a lot of potential to read, record, and predict actions. This could really improve how we deliver care.

Now that EMRs are the norm and we have access to more data than ever before, what initiatives would you like to see more focus on in the coming years?

Smart-charting rather than billing-compliance charting. A lot of information is already in the record but needs to be accessible and digestible. We need a better way to pull in or point to relevant info and eliminate double-documenting or over-document for billing and compliance sake, which exacerbates the problem of finding pertinent information.

Also, as I mentioned before, we should focus on patients being able to interact with their record.

Are there any questions that you would like to see answered using big data?

This is a huge deal, big data. We assume what we did helped. Anesthesiologists get the most immediate feedback and get more feedback than anyone, but there is so much more we could find out about how the things we do, tests we order, etc. affect outcomes at a statistical level. For example, if a person has specific risk factors and we do treatment A instead of treatment B, what is the chance that X will happen. We should be focusing on finding out what happens to a patient based on choices, looking at outcomes of care.

To get to this level, we need to track what patients are doing when they go home. For example, we may have done a good job managing PONV (postoperative nausea and vomiting) during the case, but we aren’t usually sure what happens when the patient goes home. If they had an easy way to enter things like pain score or when they threw up, that data could really help close the feedback loop. Taking it a bit further, what if they could scan their pill bottle with their phone when they take their pills so we could track medication adherence.   

On another note, I can’t wait to see how big data can work with AI and learning systems to present you with the info you need in the record.

What do you see as the biggest improvement in healthcare the last 5 years?

Legibility. You can actually read what is in the record! That said, note bloat and macros (tools to speed up charting) have also lead to documentation by exception without consequences.

I value the decision support made possible by discrete data; I can be alerted of a difficult airway, and then search the chart to find pertinent info.

But when we talk about where computers should be, I’d like to be able to click on something and get more info as opposed to needing to search for the relevant info. The system should be able to follow a story and pursue a particular problem. It should be more sophisticated. Again, I think AI will be able to help with this.

I’d also like to see keywords colored or something in the chart. If you click on the word, it would be like a search or a mind map, so you can drill down and see the story about that problem.

What is something you have to deal with on a regular basis as a provider that isn’t widely known?

Physicians spend a lot of time convincing people to do things they don’t want to do. I’m interested to see more behavior technologies to make it easier for people to comply. In that same vein, technologies to help alert care teams to intervene if the patient is falling off of their treatment goals would be incredibly helpful (ex. not using their sleep apnea machine, not taking their medications).  

We also deal with a lot of typing and heavy computer use, and older clinicians are unnecessarily slowed down or pushed out of the field because of this. You shouldn’t have to understand machines to be able to interact with a machine. We have the technology to be able to help and make things easier… you should be able to talk to any computer to command it to take actions, and to document using voice to text. I’d like to see tech adopted in such a way.

What drove you to healthcare? How did you decide on your specialty?

Science, physiology, and intellectual curiosity that has a practical purpose. But it is better to ask what keeps you in healthcare? If I were to ask you if you were the same person you were ten years ago, what would you say?

Good point. Okay, so what keeps you in healthcare?

I love talking to patients. Talking to different people every day about personal things and being able to comfort them. To take people who are in pain and fix them instantly.

Also, I like that I can read notes now! I like that we are in the age of EMRs. It helps me stay.

A special thank-you to Dr. Breneman for helping us kick-off this series.
If you’re interested in learning more about healthcare through the eyes of the physicians and clinicians who practice every day, be sure to subscribe below for updates!