Concerns among stakeholders may call for EHR system revamping
Electronic health records (EHRs) were supposed to make healthcare easier and more efficient. But healthcare executives are realizing that many systems are not running as efficiently as expected, and that some staff members believe that the technology has made their jobs more difficult.
Only 34% of physicians report being satisfied or very satisfied with their EHRs, 54% say their EHR system has increased their total operating costs, and 43% say they have yet to overcome productivity challenges related to their EHR system, according to a survey of nearly 1,000 physicians by the American Medical Association and AmericanEHR Partners released in August 2015.
Many physicians, staff members, executives, and lawmakers believe that in order for the information highway to run smoothly between the healthcare systems, EHRs must be revamped in the future.
“I think that all EHRs today sort of suck, at least from a provider point of view,” says Ed Park, executive vice president and chief operating officer of athenahealth. “Part of the issue here is that EHRs have multiple masters-more than half of EHR functionality is there to support the lawyers and insurance companies, not the providers of care. In order to get to a perfect EHR system, we’d have to change the requirements for the amount of documentation required so there’s more signal and less noise.”
When asked, “What makes the perfect EHR system and how long until it exists?” experts say that the mix between government regulations, interoperability and costs must be retooled, and it’s hard to predict when that will be.
“Unfortunately, the phrase ‘electronic health record’ has been so tainted, I doubt physicians will ever love EHRs,” says Charles Webster, MD, MSIE, MSIS, a medical informatics marketing/work flow technology expert, and president of EHR Workflow, Inc. “Over time, alternatives to EHRs will appear and gain adherents in the medical community. These will be work flow-based systems, laid down atop current database systems, increasingly relegating EHRs to commoditized plumbing.”
Meaningful use, which has propelled many physicians to implement EHRs, isn’t going away. In January, the Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt said that meaningful use would be “effectively over” in 2016 and “replaced with something better.” Slavitt has since dialed back his definitive comments, writing on the CMS blog that EHR incentive programs will be more focused on care and rewarding providers on outcomes in the future.
A common sentiment among the healthcare IT community is that meaningful use has stunted the EHR progression. “In the words of more than one hospital CIO I've spoken with, meaningful use ‘sucked the air out of the room,’” Webster says. “Between meaningful use, ICD-10, and other government mandates, there were no resources left over to address other needs or to think creatively and experiment.”
WisePatricia Wise, RN, MS, MA, FHIMSS, vice president of health information systems for the Healthcare Information and Management Systems Society, says that the shifting mindset that EHR technology is ruled by regulation and data collection, when it should inform work flow and improve outcomes, will be significant. “Before the goal was to keep software in line with regulatory demands,” Wise says. “Clients’ needs and requests didn’t receive priority. The significant amount of regulations has been a challenge.”
Park says communication between providers is the most essential part of EHR technology, a part that he admits the industry has lost sight of.
Park“The majority of patients no longer get seen at one institution-they go to urgent care clinics, specialists, or primary care physicians unaffiliated with hospitals. And every provider is looking at the world through a toilet paper tube, getting only a fine slice view of the patient,” Park says. “What we need to solve for now is opening up providers’ lens to view the whole patient while not overwhelming them with unnecessary information and wreaking havoc with their work flow.”
Webster says that the next five years will build on the kind of interoperability that actually gets work done. “Most healthcare interoperability to date has focused on syntactic and semantic interoperability. Syntax is message structure. Semantics is message meaning. You need both to move data between systems and have it mean the same thing in both systems,” Webster says. “What's been missing from healthcare interoperability has been what is called task, work flow, or pragmatic interoperability. To understand pragmatic interoperability you need to understand syntactic and semantic interoperability.”
Wise says that the Office of the National Coordinator for Health Information Technology hopes to incentivize EHR vendors who are extending their platforms to include application program interfaces (APIs). This will help consolidate the industry and give providers a way to better customize their systems, he says.
An API is a set of programming instructions and standards that software companies can release so that other software applications can be built to interface with each other using the web.
With all of the EHR challenges and complaints associated with them, many healthcare executives fear that they will have to make dramatic and costly overhauls to their current systems. Park says, however, that trends in technology are bending toward rental content and adaptations to pre-existing systems with lower costs.
“By way of example, in Silicon Valley new startups today don’t make ‘big iron’ technology purchases of servers to run their businesses,” Park says. “Similarly in the consumer world, the trend is away from purchasing CDs and DVDs, but instead renting content from companies like Spotify and Netflix. We think that the same thing should happen in healthcare, where organizations are less reliant on traditional vendors that require big upfront costs and disruptive replacements.”
Wise agrees, adding that once APIs are used more routinely, the costs of technology should drop, but so should other operational costs. “When we have true interoperability, not only should we see lower technology costs, but gains in shared information and care coordination should cut costs also,” Wise says.
Donna Marbury is a writer in Columbus, Ohio.