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By Baha Zeidan, CEO Azalea Health
As the northern hemisphere is dealing with a winter surge of coronavirus cases far greater than the initial surges seen earlier in 2020, clinicians have the benefit of experience facing those initial surges in addressing this current and more severe strain on care networks. While frontline care providers had to figure out on the fly how to keep COVID-19 patients alive, management teams at hospitals and other care facilities had to adjust operating procedures in order to manage the pandemic response while continuing to address the broader healthcare needs of the communities they serve.
Chief among the operational changes healthcare facilities had to consider was how to optimize IT systems to support clinicians and other frontline workers collaborating to deliver care both to COVID patients and other patient cohorts amid pandemic protocols never before enacted to such a wide-ranging extent. What were some of the most significant changes that healthcare IT systems needed to support?
- Unprecedented scaling of telehealth services to continue non-COVID care and maintain revenue
- Expanded behavioral health capacity to support spikes in demand for acute care cases
- Billing accommodations to address the rapid changes in care delivery
- Increased communication between care providers and payers to ensure continuity of care for all patients
With wider and faster fluctuations in revenue models keeping care facilities continually off balance, many executive leaders have found their facilities’ IT stacks lacking in the flexibility needed to absorb the constant shocks to operations.
IT Shortcomings: The Legacy EHR
Many hospitals have found their primary technology tool supporting clinicians — the EHR — too rigid and inflexible to address the contortions to patient workflows care facilities instituted in the response to the pandemic. For these facilities, 2020 was about exerting an inordinate number of person-hours to continue providing critical care, not lose track of non-COVID patients, and keep the revenue stream intact in order to maintain operations.
While EHRs are ubiquitous across the healthcare delivery landscape, most EHR solutions in use today in any setting — from the largest hospital networks serving the most dense patient populations to the smallest facilities serving rural communities spread out over vast distances — were built in a time that preceded the era of digital transformation. Without the cloud agility and Open API flexibility that are hallmarks of digital transformation, these outdated EHR solutions lack the customizability needed to accommodate never-before-seen workflows and connect to other systems supporting healthy operations.
With EHRs as the centerpiece of the healthcare IT tech stack, care facilities relying on these legacy solutions are not only operating far below peak efficiency, they face an added challenge to provide the best care possible at a time when nothing less than the best can be a matter of life and death for patients and the clinicians who care for them.
The Toll of Ineffective healthcare IT on Clinicians and Patients
Without an agile, cloud-based EHR solution engineered to keep the focus on patient outcomes at all times, the EHR can easily become an obstacle to quality patient care rather than a facilitator. It’s said that the best-designed technology gets out of the way of the user, allowing for a more intuitive connection between data and the user’s brain. For clinicians who don’t have the benefit of working with a more patient-centered EHR, the experience can produce an extreme, opposite result.
Clinicians saddled with inflexible EHRs frequently report frustrations of working with these more intrusive systems. They complain about their EHRs interfering with the patient relationship, providing insufficient clinical value, requiring too many clicks or too much time spent on documentation, and creating slow, inefficient workflows. In fact, a recent Stanford poll of clinicians found that a staggering seven out of 10 physicians feel that poorly designed EHRs greatly contribute to physician burnout. For a technology originally envisioned to elevate patient care, this is a damning statistic. When considered in the context of today’s fight against COVID-19, there’s absolutely no place for a healthcare IT tool that undermines clinical teams’ efforts to save lives.
And when looking beyond the confines of the individual care facility, the problem of ineffective healthcare IT is magnified. In 2016, the 21st Century Cures Act was signed into law. This legislation established the concept of “interoperability” and committed resources to support the development of health information technology that “enables the secure exchange of electronic health information with, and use of electronic health information from, other health information technology without special effort on the part of the user.” Legacy EHRs that don’t support interoperability are hampered in sending or receiving patient data between care providers. With hospitals near, at, or even beyond capacity, we’re now seeing unprecedented levels of patient transfers. A critical care facility that can’t tap into its state health information exchange (HIE) will very likely experience costly lags in receiving patient data when functioning on either end of a patient transfer. Such lags can easily be the root of dire circumstances.
Inflexible HealthTech Adds to Back-Office Challenges
Connecting the clinical side of the hospital to the financial side is one of the most important functions of healthcare IT. Managing an ambulatory practice or health clinic is challenging under the best of circumstances. When relying on legacy healthcare IT solutions, care facilities can experience tremendous frustration with all aspects of revenue cycle management. Staying on top of billing and collections and minimizing denials are key to making sure a practice has the revenue it needs to stay financially healthy. Again, the context of the pandemic amplifies both the challenges and the repercussions of not having a comprehensive technology solution to support end-to-end operations.
One Patient, One Record: A New Outlook for a New Year
Modern healthcare IT solutions take a “platform approach” to providing support to care facilities. A platform approach means that the vendor can comprehensively address both the care facility’s clinical and back-office needs, either through components the vendor has developed or through ready-made integrations between the vendor’s components and code developed by other companies. Such integrations are made possible (and easy) by application programming interfaces (APIs), software expressly written to create compatibility between technology solutions from different vendors.
The 21st Century Cures Act is encouraging new vendors to enter the healthcare IT marketplace with API-driven, interoperable solutions that promote the free flow of patient data. As more care facilities adopt an interoperable stance, health information will centralize around the patient, enabling a “one patient, one record” approach to health information and the software systems that manage it.
Care facilities will combine interoperable solutions as needed to deal with the rapid scaling of certain service lines like behavioral health and telemedicine, the temporary and in some cases prolonged suspension of other service lines like elective surgeries, and the communications among providers, payers and patients that make timely billing and payments possible. In healthcare as in every other industry, change is certain. Assuring that clinicians have access to the right information is essential to supporting their wellbeing and maximizing their efficacy. And keeping hospitals solvent is always mission-critical.
Ultimately, the goal of interoperability is to improve healthcare delivery. At the same time, though, a platform approach to healthcare IT can put hospitals and other providers on more stable financial ground by making them more agile in responding to the changing needs of the communities they serve. By integrating EHR systems with scheduling, revenue cycle management and patient engagement features, providers can lower costs, raise quality scores, and improve patient outcomes. And really, is there anything less patients should expect and demand of providers and the technology they utilize?