In recent years, hospitals and health systems have made significant investments in EHRs. However, both clinicians and business leaders have discovered that EHRs can't do it all. Integration with other technology is essential to creating a comprehensive healthcare IT ecosystem.
At Becker's Hospital Review's 5th Annual Health IT + Revenue Cycle Conference in Chicago, leaders from Ingenious Med, a healthcare technology solutions provider, hosted an executive roundtable to explore the current state of the EHR market and how complementary systems can optimize EHR performance. Laura Chapman, Vice President of Product Management, and Kevin Nicholas, Vice President of Marketing, facilitated the discussion.
The current state of EHRs: How the market looks today
In the inpatient sector, the EHR market has consolidated to a few major players, especially in large hospitals. Among hospitals with 500 or more beds, Epic has 58 percent market share and Cerner now has 27 percent, according to a 2019 report from the research firm KLAS.
The outpatient market is more fragmented. Epic is still a leader with 28 percent share, but all the other players have less than 10 percent share. Ms. Chapman noted, "In specialty groups, workflows are different than hospitals. The big EHRs often don't accommodate their specific needs and pain points to provide an optimal solution. This is concerning considering the outpatient market continues to grow."
Ingenious Med recently conducted a survey in which participants identified the biggest challenges that their EHRs failed to meet. The top responses were interoperability and continuum of care (47 percent), data visualization and timely insights (45 percent) and billing accuracy and timeliness (36 percent).
Mr. Nicholas said, "I'm not at all surprised to see interoperability at the top of the list of challenges. It's a real opportunity and also a hurdle that must be cleared before we can achieve value-based care." EHR companies are beginning to build secure application programming interfaces (APIs) that enable developers to build more integrated applications. Examples include Epic's App Orchard and Cerner's SMART on FHIR platform.
EHRs are powerful tools, but they still have limitations
EHRs handle a broad array of information ranging from clinical data to hospital performance metrics. These systems increase capture and storage of patient data, merge productivity with quality measures to determine clinical best practices and push alerts about noncompliance with public data or black box warnings.
Despite these strengths, EHRs simply can't do everything well. As a result, many hospital executives aren't fully satisfied with their EHR solutions. In 2018, Sage Growth Partners surveyed 100 health system executives about the capabilities needed in EHRs, as well as their satisfaction with current EHR capabilities. Most expressed dissatisfaction with the ability of their organization's EHR to support care coordination, risk stratification, decision support and patient engagement.
Many opportunities exist to enhance EHRs. For instance, machine learning can produce more accurate forecasts of optimal staffing levels and patients' length of stay. Mr. Nicholas observed, "There needs to be a path from fee-for-service to value-based care. That will come with analytics and length-of-stay metrics."
Mobile interfaces are also growing in popularity. Ms. Chapman explained, "Physicians are used to doing everything on their phones, so why should capturing charges and looking at data be any different? A lot of EHRs are web-focused. I think it irritates people when they need to sit at a computer to use a system."
Using complementary systems to close the gaps and optimize EHR performance
Although some EHRs include revenue capture functionality, many customers experience revenue leakage when they move to those systems. Ingenious Med is designed primarily for revenue capture and it is used by 70 percent of the largest physician management groups and health systems in the country. Ingenious Med augments EHRs and aligns physician productivity with hospital performance.
Ms. Chapman noted that some healthcare systems offer telemedicine to attract patients, but don't capture charges. This leaves money on the table. She said, "If you don't try to capture these charges, you definitely won't get reimbursed. Ingenious Med supports coding capture for telemedicine."
Scripps Health in San Diego partnered with Ingenious Med and views the solution as an "insurance policy." Mr. Nicholas said, "We make sure that you capture all of your charges when an EHR is being implemented and beyond. We can reconcile information back with what you see for charge capture at the physician and caregiver level at the point of care."
As EHRs offer access to more patient documentation through APIs, Ingenious Med pulls in more information from physician notes. The goal is to document the diagnosis, which makes the charge entry process much faster.
Ingenious Med stays abreast of changes related to coding, compliance and value-based care. The solution supports both mobile and web interfaces, as well as data dashboards with the key performance indicators and metrics that physicians and administrators care about. Ingenious Med isn't locked into the EHR system and isn't locked in to one location; it captures charges across the care continuum.
Conclusion
Although EHRs have tried to be all things to all people, they often have gaps on the business side. Healthcare leaders want to know whether they will hit or miss their targets, as well as how to run their businesses better. Ms. Chapman commented, "An area that's emerging is the opportunity to help the healthcare ecosystem manage costs better. Data, analytics and software will get us there."