Considering the United States spends nearly 18% of GDP on healthcare, it is puzzling to think the industry is so behind when it comes to using technology in everyday processes. Although there are tremendous advancements in artificial intelligence, the Internet of Things, and big data computing, most healthcare organizations still rely heavily on the fax machine to communicate with other facilities, fill lab orders, and get payment approval from insurance companies.
In a fragmented system in which many providers are just now embarking on the journey of EMR/EHR integrations, it is often difficult to see a future where healthcare technologies coordinate seamlessly with one another to deliver better care quality.
Over the last two decades, healthcare providers, mainly hospitals, have been steadily moving away from paper-based files towards electronic systems including those provided by Cerner, EPIC, McKesson, and Allscripts. This process has been slow moving and although 90% of hospitals have made the change to EMRs, based on the number of hospitals reporting to CMS’s EHR incentive program, many physicians, nursing facilities, surgery centers, and home health agencies rely on paper-based and outdated systems. Without the upside of financial incentives and the high costs of implementation, integrations, upkeep, and reporting, many of these smaller facilities are unable to install electronic-based systems.
Dr. Michael Kleinman, a general surgeon based in Houston, Texas, has worked with many EHRs since hospitals started making the shift away from paper-based files in the late 90’s. “The only reason care providers were willing to move from the security and ease of the traditional filing system was because of the promise of a better more efficient way of doing things. Although there are many benefits to using digital systems, there are more limitations and challenges than most providers bargained for.”
When it comes to the topic of interoperability, the spotlight is almost immediately thrust upon EMR providers. While these companies play a major role in the day-to-day aspects of patient care, innovators in healthcare technology, including those outside the EMR ecosystem, will likely play the biggest role in finding ways to deliver on the promise for an interoperable and better communication and documentation system.
An inhibitor to quality patient care
Within one healthcare system, it is not unheard of to have half a dozen systems for tracking, monitoring, and analyzing patient information. The problem is less in the number of systems being used, but in the fact that those systems don’t speak to each other. This leads to duplicative data entry, inefficient use of labor time, and many unrealized opportunities to improve patient care. Even worse is that these challenges put immense burdens on the clinicians providing care that lead to daily frustrations, staff burnout, and in extreme cases, preventable errors, all of which costing millions in unnecessary healthcare expenses.
Although there are requirements in place for providers to document patient information such as care plans, follow-up calls, and provider communication, the data is often siloed and accessible through scanned and faxed pieces of paper. For smaller providers such as local ambulatory centers, regulatory requirements don’t fix their outdated systems.
Kate Huber, Senior Vice President of Product at CipherHealth, has seen first-hand how inefficient technology leads to unnecessary burden on clinicians. “We work to make it easier for providers to engage patients and then document those interactions within their typical systems. What astonishes me are how many of these providers still need to print, scan, and fax information because the electronic systems they use either lack the functionality to integrate or cost an exorbitant amount to have a vendor integrate. It takes a great deal of time and energy away from activities that could be better spent in caring for patients,” said Huber. “When providers use outdated and inflexible systems, not only is it difficult to obtain the right information, the clunky processresults in a significant inefficiency of staff time.”
Even within newer systems and advanced EMRs, these challenges are widespread and have a sweeping impact across the healthcare ecosystem. So the question begs, ‘how is this going to be resolved?’
Interoperability: EMR Companies do not have the answer
Although the fragmented EMR ecosystem is at the heart of the interoperability issue, getting EPIC systems to communicate with Cerner or Cerner to McKesson is not likely to happen in the near future. Although each EMR company can play a role in helping make interoperability a reality, to truly address the issue, the healthcare industry needs solutions that can take in and display information in a meaningful way that can help close gaps in care and streamline processes.
“A first step to interoperability will be digitizing paper-based documentation. Once that happens, the information needs to be displayed and communicated in ways that are easy to access, analyze, and act upon. This can then help proactively address individual patient needs, as well as improve the health of entire communities,” stated Huber.
Whether it is analyzing large patient populations or understanding how to best improve care for an individual patient, finding the right information is currently a resource-heavy task for most institutions. The problem is not the lack of information, but that the information needed to make proactive improvements is difficult to track down.
Dr. Kleinman states, “As a physician working with patients, it can be extremely frustrating trying to track down all the right pieces of information to see the full patient story. Entering and tracking down everything in the right places takes a lot of my time, my staff’s time, and patient’s time. It leads to poorer experiences across the board.”
The shift from volume to value and the importance of technology
As the United States starts to move away from the fee-for-service model, providers will need to work within and across the patient journey more efficiently than ever before. This is already the case with mandatory bundled payment programs and is forcing providers to look at data and technology in new ways.
“We are already seeing how value-based payment structures are impacting the way providers look at communication and care coordination. They are realizing that it is a financial and resource burden to integrate across their networks and create visibility within individual patient care. With so many moving targets related to mandates and incentives, providers need flexible systems to keep up,” noted Huber.
Value-based purchasing programs for both acute and post-acute providers are encouraging collaboration and communication with patients and providers. To facilitate effective communication, technology tools that can take information from multiple sources, including the patient him/herself will be of increasing importance.
Additionally, return on investment will be seen from a new perspective. With incentives aligned towards patient satisfaction and improved outcomes, healthcare leaders are now seeking opportunities to cut costs from more than the sticker price.
“Instead of seeing how much something costs, successful healthcare systems will explore the value it brings. For surgical procedures, instead of choosing the cheapest equipment, value-based care organizations will choose the product that shortens the length of stay, reduces infections, and satisfies clinicians and patients,” stated Dr. Kleinman.
What to expect from Interoperability
With shifts in payment structures, patient perceptions of care, and technology, providers can anticipate new technologies that help maximize time and resources. Instead of looking for a better EMR, there will be solutions to take and display relevant information from any source, implement any kind of workflows, and help providers proactively address issues.
With the promise of interoperability comes the ability to better care for patients, efficiently and in ways that put their needs first. As technology finds its way to creating a better and more integrated system, data will be seamlessly collected, analyzed, and displays that make healthcare easier for providers and patients alike.
“What I hope to see is the promise of a better, easier system realized. To see that moving away from the security of the paper-based system was not done just because it seemed like the better alternative, but that it is the better alternative. When you think about all the moving pieces in taking care of one patient, finding ways to make clinician’s workflows easier and more informed is well worth the investment,” stated Dr. Kleinman.