Siloed EHR systems and a lack of data standardization are feeding current healthcare interoperability issues.
By Joel A. Kahn, MD
Problems with healthcare interoperability are not new obstacles for providers and are in fact just the latest hurdle when it comes to ensuring that patient data is easily accessible. With paper records, the process of accessing information was often delayed because physical copies would need to be obtained. This is where electronic health records (EHRs) came into play, ideally making healthcare better connected and improving patient care.
But the transition has not been so smooth, and EHR utilization comes with its own accessibility issues and can place additional burdens onto providers.
EHRs were created to aid physicians and other providers, patients, and the administration. Sometimes it seems like all they do is add to the administrative work without providing meaningful clinical value. So how can providers get true value out of their EHR?
EHRs are not living up to their expectations
The Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law in 2009, underlining the need for “the adoption and meaningful use of health information technology.” Privacy and security were also top considerations with the HITECH Act, so that the electronic transmission of health information would not compromise patient data.
With EHRs, “health information can be created and managed by authorized providers in a digital format capable of being shared with other providers across more than one health care organization,” according to the Office of the National Coordinator for Health Information Technology (ONC). However, the goal of being able to seamlessly and securely communicate has frequently not lived up to the original expectations.
HIMSS Analytics found that the average hospital has 16 disparate electronic medical record (EMR) vendors in use at affiliated practices, with only 2% having a single vendor. Many of these are specialty EHR’s, but that still contributes to the inability to share clinical data across the institution.
Centralized enterprise EHRs were meant to help with interoperability by getting rid of “best of breed” solutions. However, these centralized systems haven’t always been able to provide the best capabilities in certain areas, like oncology, so different systems remain. This creates additional burdens on reporting and analytics since many institutions allow each department to define metrics differently. This has created additional data silos. For example, the definition of Length of Stay (LOS) may not be defined the same way in every department.
What are the unexpected EHR burdens?
The use of an EHR by itself also comes with numerous reporting requirements related to “meaningful use” if there is an expectation of additional reimbursement from the government, adding to the administrative burden.
For example, physicians spend two minutes at the computer for every minute spent with patients, according to researchers from the University of New Mexico (UNM). In addition to documenting patient medical history, EHRs now are being used to document against potential medical malpractice, collect additional information for quality assurance initiatives, and support billing processes. Governmental policy oversight processes are also part of the EHR process, researchers said.
Alert fatigue, from being overwhelmed by the large number of EHR notifications, is another common problem from using an EHR. One study found that physiologic monitors in a 66-bed unit academic hospital generated more than 2 million alerts in one month, which was about 187 warnings per patient per day. And 3% to 6% of all orders generated a warning, creating potentially dozens of additional alerts every day.
Twenty years ago, when EHR’s were just rolling out, one of the goals for a digitized medical record system was to allow commonality amongst data elements for a hospital. This would help provide an accurate picture of an individual’s diagnoses, conditions, treatments, medications, etc. And it would all be electronic, making analytics and decision support much easier.
The reality is, depending on the system put in, EHRs even in a single hospital didn’t communicate with each other. Frequently, departments were able to modify or use different standardized vocabularies, creating an inability to effectively analyze the data and made useful decision support much more complicated. Without a way to effectively and efficiently utilize the data, it will continue to be difficult for organizations to maximize the use of an EHR.
Using health data effectively, efficiently
Every day, more data is created, utilized, and stored in healthcare. Patients interact with physicians and nurses via telehealth, answer online surveys about their health and functioning, and use wearable and other biometric devices. With such increased amounts of information, it is even more essential for providers to have access to all that data as well. But it must be accessible, meaningful, and usable in ways that are convenient to the physician, while still staying secure.
Figuring out an effective way to get health information into the EHR, decreasing unneeded documentation, automating more features, providing contextual support during patient interactions and generally decreasing the administrative burden, all help ensure quality patient care. A little EHR fatigue prevention would certainly help with physician burnout. Then using that data by breaking down data silos, increasing interoperability, and making data usable and actionable would make the EHR useful in improving clinical care.
It’s essential for healthcare to recognize the need for truly streamlined and meaningful data. This data should and will become the foundation for simpler, more intelligent and more efficient health systems. It’s not just about having an EHR, it’s about having a useful EHR.
Dr. Joel A. Kahn is the Chief Medical Officer of First Line Software where he focuses on driving their global health solutions. He has been exploring the intersection of business, healthcare and technology for more than 25 years and has been focused on executive management, operations, compliance, analytics, technology and their application in the healthcare and wellness industry.