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December 19, 2024
As healthcare systems strive to provide better care while streamlining processes and improving patient satisfaction, efficient selection and implementation of electronic health records (EHRs) are becoming increasingly important. As of 2021, nearly 78% of office-based physicians and almost 96% of non-federal acute care hospitals have adopted a certified EHR – a substantial increase since 2011 when 28% of hospitals and 34% of physicians had adopted an EHR. Today, EHRs have the potential to save healthcare providers up to $78 billion per year in healthcare costs.
For Dr. Stephanie Lahr, President at Artisight & former CIO/CMIO at Monument Health, the devastation caused by Hurricane Ike highlighted the importance of EHRs. She shares how “after that hurricane, within two weeks I was in a strip mall in Texas City just on the other side of the causeway in an office essentially with a computer, a fax machine and a phone. I was able to at that time, without much real drama or intense talk with patients, see their records – if they had been in the hospital recently, if they had been in the clinic recently. I had a full understanding of what was going on. So while patients were struggling – with things like medications either not working because of the additional stress or that they didn't have them, or that something was changing – I was able to dig right in, see what was happening, help them come up with a new plan, e-prescribe medications wherever it was they were. For me it was a moment of ‘for all the trials and tribulations of going through an implementation, we can never go back.’ I mean the paper literally still existed but it was underwater, so we wouldn't have been able to do any of that stuff.”
With EHRs becoming commonplace across hospital and healthcare settings in North America, an improved EHR with interoperable and integrated tech can benefit both healthcare providers and patient population. As Dr. Damon Broyles, Vice President of Clinical Innovation at Mercy Technology Services, emphasizes, startups trying to break into the healthcare technology market make two critical mistakes – one, they do not understand the complexity of the sales cycle in healthcare and the many “different stakeholders sitting over here and the purchasing power sits over here. The ability to tell a different but pertinent story to each of those stakeholders is really important”; and two, they cannot clearly articulate if the technology is “a product or a feature. Because being a feature of a large EHR is much more of a challenge than to develop a fully mature product.”
EHR systems can become more efficient by integrating technologies that help with standardization, interoperability, workflow optimization and ultimately enhanced patient outcomes and experience. It allows for the efficient and effective sharing of information within and outside the health system, without the risk of information blocking or other access issues.
Here are seven key considerations and benefits to adopting technology that integrates well with existing EHRs to truly create an interoperable system – according to healthcare leaders across North America.
Why adopt tech that integrates
According to a report by Grand View Research, the global EHR market was valued at $28.1 billion in 2022 and is expected to reach $38.5 billion by 2030 – a growth that is foreseeably going to significantly boost healthcare industry growth – and healthcare technologies that integrate will win the race.
- Improves data interoperability
Interoperability between digital health solutions and EHR systems is critical for streamlining clinical workflows. According to Suja Chandra, Global Chief Executive and former Chief Information & Digital Officer at CommonSpirit Health, healthcare suffers from limited interoperability and application of advanced techniques to parse the enormous amount of data, everything from handwritten notes to equipment in an intensive care unit. She shares that “all the way from the drug discovery to value-based care and closing the healthcare loop, it's data. But the amount of interoperability is very limited, the amount of machine learning or advanced techniques applied to tame this complexity of data is also limited. Also the data models vary, so there's a lot of complexities.”
In creating KeyCare, a virtual care platform built on Epic, CEO Dr. Lyle Berkowitz wanted to help connect health systems to a nationwide network of virtual care groups “to support particularly what I call the Triple R threat that's drowning their doctors: Routine, Repeatable, Rules-based care. How do we make this workforce as efficient as possible by using technology, virtual care, etc. By putting it all onto our Epic platform, because we now have an instance of Epic, we're able to use interoperability functionality that allows our providers to more easily manage anyone – particularly who's using an Epic system themselves – because the patient can have an appointment that can span across both instances, all the data is shared, etc.”
- Integrates into an existing workflow to avoid disruptions
Future-proofing investment on a digital tool that evolves as a health system’s needs and its EHR evolves is key. “Thinking of the “EMR as a platform … and apps built on top of that” and answering these questions when implementing tech that can be interoperable with existing EMRs allow for easy scalability according to Dr. Berkowitz.
For Dr. Heather Evans, Vice Chair of Clinical Research and Applied Informatics at MUSC, having a “skunkworks” team to build an app for patient wound monitoring enabled them to very early on figure out that “for us to be Innovative and really cutting edge, we had to be outside of the system that worked outside the EHR system” and the process revealed "the tension between the stability, security, privacy, and zero downtime environment that we live in as medical informaticists that practice medicine versus those of us that really want to push and change and grow and refine and open new ways of communicating with each other.”
Dr. Evans introspects that while mPOWER, the tool for patients to monitor surgical wound recovery at home, was very helpful, it “is a failure because we couldn't integrate it into the physician's work process. I think it goes back to that initial choice of being skunkworks and not working with the EHR folks and not integrating with Epic or Cerner or Allscripts or whatever EHR you're using. If you were going to ask me where the rubber meets the road and where we're going with all of this stuff, it's that I think that integration is everything. The less that you're going to do something that's going to get in the way of a person delivering care to somebody else … the more successful it's going to be.”
Finding support tools that embed into providers and our clinicians natural workflows “instead of taking them out of their workflow or stopping them really” is key to reducing friction in the adoption and sustainment of new tools in healthcare, suggests Dr. Keith Woeltje, CMIO at Froedtert Health & Medical College of Wisconsin.
There are a number of factors involved to assess whether or not a digital health tool, for instance digital patient engagement platforms, can effectively integrate into your EHR/EMR system in its current state as well as align with your long term EHR strategy. As such, consider looking at solutions that are already listed as validated integration partners for EHRs, such as the platforms formally tested, validated, and listed on Epic's Connection Hub and Oracle Cerner’s CODE program.
- Creates a cohesive platform
Brian Dobosh, Vice President of Digital Health Systems at RWJBarnabas Health, considers adding a new feature or technology only if it can integrate with Epic, or if it will be added in an upcoming update, to avoid adding a lot of vendors and creating a "Frankenstein" system with duplicate functionality. This was true even as RWJBarnabas went from seven different EMRs to a single EHR system.
Dobosh explains his metaphor of the "Frankenstein" EMR system as a situation where a healthcare organization has multiple EMR systems that do not interact well with each other, and “there's a lot of maintenance, third-party vendors trying to connect all the dots, a lot of dollars that you put into that just to keep it alive. But you're never getting the full use out of any of those products because you're just trying to make sure that nothing stops working. And not [being able to] go the extra step to getting the features that really would make a difference.” The alternative approach, according to Dobosh, is the "Onion", where each layer of technology builds (on the core of the EHR), including internal and external sharing with partners and affiliates, access for referral networks, all with the goal of increasing the interoperability of all the data and providing that continuity of care.
- Offers holistic patient experience
Considering the vast amount of patient data across an organization, it is important to ensure that technology, such as digital patient engagement and remote monitoring tools, are compatible with the EHR. This is not just to ensure that the EHR and its tools are able to communicate with each other to provide comprehensive information for care teams, but also enhance the patient experience throughout their entire healthcare journey.
Which is why for Dr. Berkowitz it was of paramount importance to build his virtual care platform on Epic, so that “our providers are able to see all the past data. It means a couple things. One, the patient doesn't have to repeat all their data – allergies, meds, problems, their past medical history, the results – everything's available. That means our providers can make a more informed decision about the [patient’s] health care. Vice versa, once they [providers] sign the note, it goes back into the originating health system's record, so they have access to it as they want to make decisions in the future. On top of all that, by having that data outside of urgent care, it allows us to more easily handle primary care and post-op follow-up, and serve in any type of specialties. Having that data gets incredibly important over time … Being able to make sure the patient feels that it's all connected is, both clinically and quality-wise, important. But also it's a feeling of commonality and consistency that makes them trust and feel better about getting their health care taken by a partner with the health system.”
- Enhances user experience and adoption
Alignment with physician and care team workflows is also critical to enhance the user experience and adoption. For instance, Dr. Berkowitz emphasizes the importance of user adoption in health tech, which can be enhanced when the tech is aligned with the people who use it. For him, a technology should answer the key questions: “Who uses your technology? Who benefits from it – clinically, financially, etc? Who pays for it? How are those things aligned?” Understanding the care teams’ key challenges, their “pain” is crucial to creating effective solutions for their existing workflows in the EHR/EMR and improving adoption.
For Dr. CT Lin, Chief Medical Informatics Officer at UCHealth, understanding that “even though people expect that it will be technological change that makes us better, almost none of that is true. We will fix a couple of flow sheets, build some specific diabetes things that are specific to the disease processes that you work on. But 80% of the Improvement comes from watching people do their work.”
Dr. Lin implemented the UCHealth’s EHR optimization Sprint program to improve the functionality and acceptance of the EHR, and emphasized that bringing in care teams to optimize because “if you take smart people pulled from different disciplines within the IT shop, and have them be led by a physician informaticist who understands clinical practice, you can take an EHR that is sort of out-of-the-box vanilla, and not very well accepted, from not very helpful for clinical practice to sort of outstanding in a two-week period.”
- Standardizes and provides easy access to care
EHR integration with enterprise digital patient engagement tools or remote patient monitoring platforms saves valuable time and money by reducing manual processes, streamlining workflows, and access to analytics through dashboards. It helps accelerate patient enrollment as patients can quickly and easily access the app within their chart, and it makes it easier for staff to receive alerts, and review dashboards without leaving the EHR or signing into a different system. Integration of the EHR and digital patient engagement solutions improves patient outcomes by enabling providers to send their patients instructions and reminders directly through the EHR. Providers can easily enroll patients and remotely monitor them from within the patient chart and auto-populate key data from the EHR into the digital patient engagement and remote monitoring platform saving significant time for clinical staff.
For instance, Dobosh is most excited about Remote Patient Monitoring as “there's a unique opportunity for growth, especially with the pandemic and people realizing that they're not going to always be able to go to the hospitals or or the clinics to be seen. But the use of technology especially, with iPads and and smart devices has become a lot easier, mostly because people are just getting used to it – you have older populations who are on MyChart; you have people who are using these devices that 10 years ago there's no way Grandpa Joe was going to be able to use – a phone at all let alone a smartphone. I think this area is becoming really really popular. There's a lot of use cases for a lot of the chronic diseases, there's some OB use cases that we're looking at that I think will allow us to really get into the customer's home with the technologies, so they don't have to come back every week. We can monitor everything from home without them having to do that kind of traveling. I'm really excited about it.”
- Reduces workforce burden and better aligns resources
While there has been a significant boost in EHR adoption among physicians, it has shown to often negatively impact the physicians themselves, including adding to their clerical burden, according to Dr. Lahr. She emphasizes that while technology is crucial to healthcare and its advancement, its deployment in healthcare, including EHRs, has traditionally been done at the expense of clinicians, resulting in burnout and “have actually developed a sort of negativity around technology interactions … As healthcare clinical technology leaders, we have to own that the reality is we've done some really amazing things in the last decade, but there has been a cost to some of those things and some of the collateral damage is the trust that our clinicians have that technology can really make their lives better, because the reality is we haven't proven that to them.”
But there’s hope. Better interoperability can be achieved through systems that have been developed in the same framework and language and help to create a holistic view of a patient’s health and overcome the limitations caused by an inefficient interoperable EHR in data sharing and physician decision making. According to Dr. Lahr, “Technology is at a place today where we really can do that. The EHRs are doing a better job of that all the time – like the partnerships between EHRs and some of the NLP work that's happening to reduce the burden. Everybody's working on it because we know the technology is sophisticated enough to help do those things. It's going to be chipping away at that over time and building that trust back.”
For instance, Dr. Alexander Petron, CMIO at WellSpan Health, when rolling out Ambient Voice technology, identifies physicians struggling with clinical documentation and experiencing burnout, particularly in primary care and medical specialties, and “who, after interviewing them and talking with them, want to try something new and different. You show it to them and some people go ‘that's not for me, I don't want that’, and that's fine. It's a tool and it's not designed for everybody. There are actually clinicians who have just learned so well to use the inherent tools of an EMR, whether they're natural or not to that person they work. And they're getting through their day… and it's finding that marriage that clinician who's struggling, who's having difficulty specifically with their clinical documentation, and who has a lot of pajama time and those sorts of things – writing their notes and cleaning up their documentation – and saying here try this again …Is the technology perfect? Absolutely not. Does it require human intervention at the end? Yes. But again it's the beginning of a journey – a first step. To say I'm going to wait till it's fully mature is not appropriate. It's seeing the vision, seeing the future and getting there. The fully automated modes exist. They're not as common right now but they do exist. They didn't exist a year ago and a year from now it'll be a totally different animal, and it's all part of that technology journey and change management.”
In Summary
The usage of EHRs and the need to have integrated, interoperable tools will continue to grow – in a 2021 survey, 88.2% of office-based physicians reported using any EMR/EHR system – and become vital for improving patient-centered care and outcomes as well as enhancing the value for clinicians and providers.
To hear more insights from these healthcare leaders and others who are breaking through digital transformation and healthcare barriers, tune into The Digital Patient Podcast, rated one of the top 30 Best Digital Health Podcasts by FeedSpot, here.
And if you would like to see how the SeamlessMD Digital Care Journeys – the first patient engagement platform to have validated, turnkey FHIR integrations with both Epic & Cerner via their marketplaces (Epic App Orchard and Cerner CODE) and provide integrations with Meditech and AllScripts as well, request a demo here or email us at info@seamless.md.
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