EHR Flaws and Fixes

This article was originally posted on Inside Digital Health. Dave Lareau is CEO of Medicomp Systems.

 

Rarely a week goes by without a new headline-grabbing report that highlights clinician dissatisfaction with inefficient electronic health records (EHRs). A new study from Reaction Data, for example, reveals that almost 40% of surveyed physicians working in outpatient clinics are considering a replacement of their EHR and other IT tools, and an additional one-third of clinicians claim dissatisfaction with their current systems but aren’t switching because of the expense and/or disruption to their practice.

Why do physicians want to change their EHRs? Because they desire solutions with better ease of use, more functionality and improved interoperability with other IT systems.

As a health IT veteran, I’ve witnessed firsthand the growing physician discontent with these revolutionary systems that promised to bring healthcare increased efficiencies, better care quality and even to allow doctors to leave work earlier. Since the earliest EHRs hit the market a few decades ago, IT enthusiasts have been optimistic about the potential of EHRs — yet not shocked that these systems still continue to miss the mark.

To understand some of the reasons that EHRs remain flawed — and to consider some of the ways to fix them — it’s helpful to first look back at the evolution of these systems.

ARRA and Meaningful Use

Though the earliest clinical systems were first introduced in the 1960s, funding provisions in the 2009 passage of the American Recovery and Reinvestment Act (ARRA) accelerated EHR adoption and the digitization of medical records.

Through a component called the Health Information Technology for Economic and Clinical Health (HITECH) Act, ARRA spawned the Meaningful Use program, which by many measures was a success: Between 2008 and today, EHR adoption by hospitals has jumped from 9% to 96%, and adoption by office-based physicians has climbed from 40% to 86%. To date, the government has paid providers $36 billion for their efforts.

The Meaningful Use program was flawed, however, in part due to its hasty creation. The architects didn’t have adequate time to create a detailed rollout plan to drive better patient care. Instead, they designed a program that prioritized economic stimulation and established a low bar for the adoption of EHRs.

To qualify for funds, providers needed to adopt EHRs in a relatively short time frame. Most EHRs at the time were designed to drive billing transactions and not to facilitate better patient care. As more providers adopted EHRs, vendors were forced to prioritize enhancements that helped clinicians qualify for Meaningful Use requirements, rather than R&D updates to improve EHR functionality. Over time, EHRs have largely become digitized versions of paper medical records, rather than tools to enhance the delivery of safe and effective patient care.

EHRs Today

EHRs now store massive amounts of clinical information. Unfortunately, much of the data is not easily accessed by clinicians at the “moment of need” — that is, at the point of care for clinical decision-making. We’ve largely failed to equip clinicians with systems that support clinical workflows and align with physician thought processes. Instead, we’ve presented clinicians with huge blobs of data that are not logically integrated, forcing users to waste precious “eyeball” time scrolling records to find the details relevant to an individual patient and the patient’s specific problem.

In addition to point-of-care inefficiencies, clinician productivity is further diminished because users must now track and report specific quality metrics to qualify for various quality incentive programs. Though such initiatives are designed to enhance patient care and outcomes, compliance activities can interfere with clinical workflows.

In the absence of functionality that supports an on-demand and holistic view of a patient at any time, clinicians must resort to the time-consuming task of flipping through EHR screens to locate the information they need.

Fixing EHR flaws

Despite their current flaws, EHRs are fixable if we focus on the following:
 

1. Clean data. By employing AI-based tools and other technologies, we can make better sense of all the massive blobs of unorganized data that are hidden within EHRs. Clinical data can be linked so that all relevant information on an individual patient is easily assessable, at the moment of need, within a click or two. With ready access to a patient’s complete record, clinicians will be empowered to deliver safe and effective patient care — which will also improve clinician productivity and eliminate many of the efficiencies that fuel clinician burnout.
2. Interoperability support. To make healthcare safer, more effective and cost-efficient, we must improve interoperability between disparate systems and provide clinicians with access to a patient’s complete record at the point of care. Technology alone will not solve interoperability challenges; perhaps more essential is the elimination of data blocking by vendors and providers who resist record-sharing in order to preserve market share. Government-mandated inducements, or penalties, may be required to eliminate data blocking practices.
3. App-based solutions. Most providers are not willing and able to invest the time and money for replacement IT platforms. Fortunately, organizations now have a wide variety of app-based solutions that can be incorporated into legacy EHRs using established standards such as FHIR. Many of these technologies are designed to fix inefficient workflows that diminish physician productivity. Others focus on organizing data so that clinicians can easily access the information they need on demand, even if the data are coming from an outside organization. Other app-based solutions enable more complete and accurate documentation to facilitate the delivery of care, quality tracking and reporting, and better clinical and financial outcomes. Continued development of FHIR specifications, including more detailed clinical data definitions, will be required to expand the use of app-based solutions.

Finally, clinician input is critical. To fix EHRs, we must start by asking physicians about their EHR pains and how existing systems are getting in their way and slowing them down. To improve clinician satisfaction, we must first understand what is working and what issues must be resolved. We should no longer assume that physicians will tolerate inefficient workflows that interfere with the physician-patient relationship or negatively affect productivity or patient outcomes.

By fixing flawed EHRs, we can drive greater clinician satisfaction —  and perhaps inch closer to realizing the full potential of EHRs.