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The first electronic medical record (EMR) was developed in 1972 by the Regenstreif Institute and was seen as a major advance in medical practice.
Electronic records evolved beyond capturing the patient’s history to a more complete view of the patient’s health and are now known as electronic health records (EHR). They were seen as a critical tool for improving the quality and efficiency of clinical care, so legislation was introduced to encourage their adoption. The Health Information Technology for Economic and Clinical Health Act (HITECH), a component of the American Recovery and Reinvestment Act of 2009 (ARRA), provided incentives and disincentives that led to large-scale adoption and use of EHRs.
From 2021, 88% of consulting doctors and essentially all acute care hospitals used EHRs. WE EHR expenses grew an average of 5.4% annually from 2015 to 2019, totaling $14.5 billion in 2019. And spending growth is forecast to reach $19.9 billion in 2024, from $9.9 billion in Hospital EHRs.
However, EHRs are a source of growing frustration in several areas. One concern is the burden they have created for doctors. In a Stanford Medicine Survey, 71% of physicians reported that EHRs contribute to burnout and 59% believe that EHRs need a complete overhaul. In addition, clinical burnout is already costing the U.S. health care system more 4.6 billion dollars per year. In 2020, the US Department of Health and Human Services (HHS) published a global strategy to reduce physician burden associated with entering information into EHRs, meet regulatory requirements, and improve EHR usability.
Over the decades, healthcare organizations have invested heavily in technology that has not delivered the full expected value, making the current environment ripe for change. Health systems, hospitals, and providers are challenged by five common pain points that EHRs create. As organizations look ahead, there are proven approaches to addressing these pain points.
High costs with questionable returns
As evidenced by the historical and projected growth in EHR expenditures mentioned above, healthcare providers have invested billions along with countless hours, encouraged by federal policies and regulations, but realizing the real return on their investment remains a challenge.
Many healthcare organizations are intimidated by the time, effort, and money required to complete an EHR conversion. The squeeze on margins after the COVID-19 pandemic has forced them to carefully weigh the value of every health IT dollar spent. While many recognize the potential of EHRs to improve clinical and financial outcomes, current transaction-based EHR models often fall short of these goals.
An alternative is a system-as-a-service (SYaaS) subscription model that includes all hardware, software, and ongoing support services. This approach centralizes all system implementation, optimization, and monitoring services to manage reliability and performance.
Health systems using a SYaaS model have a predictable cost that includes all current and future interfaces and ongoing IT training and implementation support, reducing labor costs and significantly reducing total cost of ownership. With continuous IT support and lower overall costs, healthcare organizations can focus on optimizing care processes and workflows to achieve better clinical and financial outcomes.
Interoperability challenges
Interoperability is at the heart of much of the frustration with EHRs, from the inability to easily share patient data to suspected data locking. It is a problem that makes the day-to-day work of doctors difficult. Seven out of 10 PCPs (67%) believe solving interoperability deficiencies should be the top priority for EHRs in the next decade, according to a Stanford Medicine survey.
Many initiatives aim to address the problem. The US government has been instrumental in driving progress through a number of initiatives.
Recently, the Office of the National Coordinator for Health Information Technology (ONC) published a Notice of Proposed Rulemaking, “Health data, technology and interoperability: certification program updates, algorithm transparency and information sharing.”
This standard is intended to build on progress made through the Trust Exchange Framework and Common Agreement (TEFCA) and other initiatives to support patients and providers across the continuum of care. Includes proposals for electronic movement of health information, new data exchange standards, electronic case reporting for both public health and emergency response, and algorithmic transparency for certified technology.
Health systems have options for EHRs that incorporate interoperability standards, but EHRs must do more than keep pace with advanced standards, such as the Rapid Care Interoperability Resource Application Programming Interface (API) of health (FHIR). They also need an adaptable and scalable database to incorporate workflows and functionality that enable organizations to integrate care processes across care settings, making care more efficient and reducing physician burden.
Clinical exhaustion
The key reason EHRs are cited as contributors to physician burnout is time. Doctors express frustration that they spend almost twice as long performing manual tasks related to the EHR while hanging out with patients. Doctors at the hospital reported spending 37 minutes on behalf of each patient, 25 of which were spent in the EHR, according to a Stanford Medicine poll. And, according to some estimates, 75% of healthcare workers may leave the profession by 2025, making it all the more urgent for healthcare organizations to seek better performing solutions.
A recent JAMA Network The editorial states that physicians are burdened with EHRs that prioritize administrative, financial and regulatory needs over clinical workflow. Doctors and their patients, he says, deserve a “technology-enhanced, patient-centered health care ecosystem designed to significantly improve outcomes at lower cost.”
When EHRs take a human-centered, physician-centered design approach, offering intuitive workflows and a seamless user interface, the EHR can stop being the focus of physicians’ days and instead , supporting them as they provide patient care, with documentation as a result. a natural byproduct of patient care interactions.
For example, with human-centered design and advanced integrations, nurses working with monitored patients report saving 15-20 minutes per patient per shift. It’s just one example of how giving doctors measurable efficiency gains can have a material and positive impact that reduces burnout.
Lack of reliability and downtime
The news is full of headlines about healthcare organizations suffering system unavailability, increasingly due to cyber attacks. In 2022, healthcare organizations in the United States experienced an average of 1,410 weekly cyberattacks per organization86% more than in 2021.
But cyber attacks are only one of the causes. Most EHRs require planned downtime for system maintenance and upgrades. And almost all organizations, 96% in one studyreported at least one unplanned EHR system downtime, while another study found that 70% of organizations experienced at least one unplanned downtime of eight hours or more.
In response to the growing threat, the US Department of Health and Human Services recently released Landscape analysis of the hospital cyber resilience initiative i new resources for healthcare organizations aimed at improving cyber security. EHRs based on modern foundational architectures that focus on security and reliability, such as those designed to meet stringent US government security requirements, can deliver the performance and data protection healthcare systems require, while they eliminate scheduled and unscheduled downtime.
Long implementation times
Because of their inherent complexity, EHR implementation projects for hospitals are a huge effort for staff across the organization and often require a year or more to complete. Implementation involves a wide range of areas, including clinical functions, billing processes, regulatory compliance, quality measurement tools, and more. The time and resources required to replace an EHR prevent many organizations from considering a change, even if their current system does not meet their needs.
An implementation alternative that emphasizes a partnership approach and includes the necessary resources can accelerate the implementation schedule while easing the burden on facility resources, resulting in a successful implementation with a high adoption and user satisfaction.
For example, in the inpatient setting, the implementation process should ensure that hospitals do not have to decrease their patient population during start-up, thus avoiding reduced productivity and lost revenue. Additionally, the implementation process should not require the organization to add staff, but instead include experienced resources that augment its team, taking responsibility for building, maintaining, training, optimizing, everything needed to deliver an implementation effective
With dedicated subject matter experts tasked with adapting the EHR to organizational policies, procedures and workflows, implementations can be completed in months, not years. For example, a large national health system brought 36 hospitals alive with a new EHR in just 18 months at a rate of two hospitals each month.
Alteration of the status quo
With healthcare organizations making large investments in EHRs, they may be getting more return on those investments. The time has come for disruptive EHRs that use proven technology to make costs reasonable and predictable, shorten time to assessment, leverage interoperability while improving security and reliability, and focus on making clinicians’ jobs easier.
Ultimately, this will shift the focus to physician well-being and bring joy back to their work while enabling organizations to achieve better clinical and financial outcomes.
Holly Urban is Vice President of Clinical Product Design at CliniComp.
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