Have EHRs been good for healthcare?

Fifteen years after meaningful use incentives propelled the shift to EHRs, health system leaders told Becker's that digitizing medical records has been a net positive for the industry — with some caveats.

"Regardless of your position, there is no doubt that EHRs have changed the face of healthcare," said Sandra Hales, associate vice president for IT clinical applications at Phoenix-based Banner Health. "Patients now have timely access to records and data that is simplified for understanding, and there's a level of inclusivity and responsibility for patients to engage in their own care."

A challenge is that clinicians commonly feel an electronic screen has come between them and their patients, often for the purpose of increasing daily documentation for reimbursement, she said. But she called the data generated from EHRs, as well as their algorithms and safety checks, "invaluable."

"Lives are saved from simple human error," she said.

In 2009, then-President Barack Obama signed into law the Health Information Technology for Economic and Clinical Health Act, aka the HITECH Act, part of a larger economic stimulus package that provided about $35 billion in incentives for hospitals that made "meaningful use" of EHRs. Many health system leaders agreed that the transition to digital wouldn't have happened as quickly, or at all, without this push.

"Meaningful use was necessary in EHR adoption and created a better and more digitized process," said Ed McCallister, CIO of Pittsburgh-based UPMC. "Over the past 15 years, we have not connected the dots as quickly to allow for a truly connected patient experience. I am confident that [artificial intelligence] will accelerate what we know as today's health record."

Laura Wilt, chief digital officer of Sacramento, Calif.-based Sutter Health, pointed to one such enhancement, a tool in Epic that employs generative AI to draft patient portal messages. The platform is being used by dozens of Sutter Health physicians, saving them time in triaging and responding to patient communications in the EHR.

"While there is always room for improvement within our field, EHRs have helped propel medicine and patient care into the modern era," Ms. Wilt said.

Michael Pfeffer, MD, CIO of Palo Alto, Calif.-based Stanford Health Care, said it's important to leverage what EHRs do well and improve upon what they don't, including optimizing all the applications that interact with them.

EHRs also laid the groundwork for the next evolution of healthcare technology. "Applying responsible AI requires healthcare to be digitized, and now we are seeing such great advances in AI that will certainly allow us to improve EHRs and transform the way we deliver healthcare," Dr. Pfeffer said.

Oakland, Calif.-based Kaiser Permanente was an early adopter, setting out to create an ambulatory EHR in 1997. The health system now has the largest private-sector EHR in the country. Completed in 2010, the EHR has streamlined care, reduced duplication and advanced research, said Kaiser Permanente Chief Medical Officer Andrew Bindman, MD.

"Our EHR system enables our teams of experts to seamlessly collaborate and coordinate care across departments and specialties and has fueled transformational health research and clinical practices that continue to improve patient outcomes," he said.

AdventHealth, a 52-hospital system based in Altamonte Springs, Fla., completed a $660 million Epic rollout in early 2023, giving its medical professionals "timely access to the clinical information they need at every point of care to provide the highest degree of whole-person care possible," said AdventHealth President and CEO Terry Shaw.

The single EHR enables providers across nine states to easily exchange patient data — "whether from across town or across the country," he said. "Our clinical teams benefit from having a more complete picture of a patient's history, thereby improving our healthcare delivery."

Kelley Curtis, PharmD, chief pharmacy officer of Boise, Idaho-based St. Luke's Health System, helped implement an EHR after a merger at her organization. She said the benefits have been innumerable: care coordination, information access, staff efficiency and productivity, data analytics and reporting, regulatory compliance, patient engagement and empowerment.

"While EHRs have their challenges, particularly in the realms of cost, technical issues, and the initial learning curve, their benefits in terms of improved patient care, enhanced communication, and better data management are substantial," she said.

"At this point, the role of EMRs is pretty undeniable: the value that it brings related to making data available at point of care, and allowing us to share records to deliver higher quality of care coordination," said Sophia Saleem, MD, chief medical information officer of New Hyde Park, N.Y.-based Northwell Health. "Really, we couldn't have achieved that without EHR."

On the flip side, she said EHRs made everything in healthcare seem like an "emergency," since patients and colleagues can easily send messages at any time, regardless of the acuity of the issue. She said EHRs were also designed for documenting appointments and not the holistic, patient-centered experience that the industry hopes to move toward.

She doesn't expect anything to replace EHRs anytime soon, as they do an adequate job of safeguarding data and boosting patient safety in a litigious healthcare industry. But she said the EHR experience could inform healthcare's shift to the next big technology. "One of the things that we missed out on with EMR implementation was really getting the clinical voice in the design of it," she said. "We should not make that mistake when it comes to AI."

Dan Roth, MD, chief clinical officer of Livonia, Mich.-based Trinity Health, said the industry is at an "inflection point" with AI, where technology has the potential to reduce clinicians' documentation workloads rather than add to them.

"In the next one, three, five years, we'll be able to significantly alleviate that burden using technologies that are coming," he said.

Still, he said, EHRs' benefits have been indisputable with medication safety having improved dramatically via barcode medication administration and care gaps being narrowed by electronic data exchange. He said EHRs went through a "hype cycle," from people thinking they would transform healthcare to disillusionment to, now, a relative plateau with gradual improvements.

"When I was in practice, we used to fax information from one practice to the other. That's a very antiquated way of doing things," he said. "And without EHRs, we might still be faxing, and, in fact, sometimes we still fax, which is crazy. I'm not aware of any other industry that still uses fax at scale."

Providers often don't appreciate EHRs until they're without them when the inevitable IT outage happens, said Joe Moscola, executive vice president of enterprise management at Northwell Health.

"The majority of our workforce is Gen Y or Gen Z," he said. "They're very much digitally native. There are certain things they're just not accustomed to being able to do without the assistance of the chart."

EHRs, meanwhile, have given way to the larger "digital transformation" in healthcare, which aims to address some of the issues where the technology fell short, including interoperability and connectivity, clinician burnout, and patient "stickiness," he said.

"On the input side, ambient listening is a total game changer," he said. "I think the core record stays the same … but what we put around the record changes substantially in the next five to 10 years."

He said "meaningful use" helped create the streamlined EHR approach that exists today. Where providers used to have disparate, sometimes homegrown records systems, they're now opting for integrated platforms (with Epic being the clear winner in that market).

Northwell is switching to Epic to put the health system "on par with the majority of the country," Mr. Moscola said, but is also tacking on a customer relationship management platform from Salesforce to fill gaps in the EHR.

"That ultimately will allow us to learn more about the patient and those around them, to understand the behavior of an individual so we also understand what's distracting him or her from their healthcare, or health," he explained. "Is it their kids? Is it their parents? This sandwich generation having to deal with issues on both sides? You're not going to get that from certain tools like Epic."

Vinay Vaidya, MD, chief medical information officer of Phoenix Children's, said early EHRs were "clunky," comparing them to the first iPhone. But they became pretty consistent about eight years ago.

"Once the EMR was stable at Phoenix Children's we said, 'We didn't implement the EMR just to replace paper. We implemented it for its value for clinical outcomes and the data,'" he recalled. "So we heavily focused on giving clinical data back to physicians. That, to us, was a game changer."

EHRs have facilitated care at home, allowing Phoenix Children's to remotely gather and monitor data from cleft palate and childhood leukemia patients, reducing malnutrition and hospital readmissions in the process, he said. EHRs also identify patients for clinical trials.

Dr. Vaidya called meaningful use incentives — to apply two healthcare analogies — "ripping the Band-Aid off" and a "shot in the arm," helping consolidate the best solutions. "It was something that was needed to reset the country, and not have 75,000 opinions on how to do things," he said.

He said EHRs have been disparaged as "death by 1,000 clicks." But providers often ask for more clicks because they understand the benefits of data collection.

"In the last two years, I have received medical care from three different states," Dr. Vaidya said. "Nowadays we take it for granted, but my appointment from one state to the other was seamless. My records were seamless, my medication list was seamless. Nobody repeated my test, they had access to it … my allergies, my surgeries."

"Instead of the glass half full, I think it's 90% there," he said of EHR technology. "The tremendous advances in artificial intelligence and machine learning now rest on the shoulders of data, and it rests on electronic data."

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