From novelty to care tool: The evolving usability of EHRs

As EHRs come to be expected in the clinical care setting, they have mostly lost their "novelty" quality, and vendors and providers are trying to figure out how to best optimize and leverage this technology to significantly improve patient care throughout the care continuum. The usability and optimization of EHRs was a key theme to emerge from a panel discussion at the Becker's Hospital Review 2nd Annual CIO/HIT + Revenue Cycle Conference Thursday in Chicago.

Around 10 to 15 years ago, EHRs were seen as a sort of novelty, and systems that offered one type of platform like computerized physician order entry may not have offered much else, said David Higginson, executive vice president, chief administrative officer and CIO of Phoenix Children's Hospital. But with federal dollars on the table, adopting EHRs became, for the most part, an accepted form of doing business, he said. Prior to meaningful use, physicians could push back against adopting the technology if they wanted to. "With MU dollars made available and money to be lost, it became a conversation of, 'We have to have this. Let's just get one in and then we'll move on from there,'" Mr. Higginson said.

Jonathan Feit, co-founder and CEO of Beyond Lucid Technologies, agreed. He said while meaningful use was the starting point for implementing EHRs in hospitals and physician offices, other parts of the healthcare continuum, like prehospital care, are now being integrated into the overall EHR conversation. Beyond Lucid Technologies develops software to connect prehospital care data with acute care providers.

Previously, Mr. Feit said prehospital care has largely been excluded from data-sharing initiatives with primary care providers and hospitals. Now, however, that is changing. "Other parts of the healthcare continuum are being brought in, which has really interesting implications when you start looking at folks like prehospital care, which is not necessarily seen as endemic to care," Mr. Feit said. "It's seen as a feeder into the care system. Now we're realizing [it provides] a lot of information that's valuable to the clinical context."

Now that more segments of the care continuum are connected, the focus is turning to usability. Once platforms can draw and connect data from EMS, primary care providers and post-acute care, what does an EHR look like that delivers those needs but is also easily usable?

Mr. Higginson said an ideal EHR is one where the technology is working in the background of care. "My sense is that the EHR is only there as a tool to serve. In a perfect world, it's not very visible to the clinician or people giving care anywhere in the care process," he said. Conversely, the least ideal scenario would be seeing a physician with a laptop, he said.

What's more, the information needs to be able to move. This is a new area of convergence between health IT and emergency services, according to Mr. Feit, who said interoperability and emergency services have only come together in recent discussions of readmission avoidance.

Many specialties and arenas of care have specialty and niche EHRs, which he said runs contrary to the idea of interoperability, and providers spend more time using the individual record systems. It's not an ideal way to utilize resources.

To address some of the issues in health IT and reach the point of ideal usability, Mr. Higginson said much of the impetus is on the vendors, and mentioned vendors' proprietary interests and the difficulties of innovating today.

First, the agents of innovation regarding EHRs and IT systems need to come from the end users, not the vendors themselves or even CIOs, according to Mr. Higginson. He said as CIO he doesn't log onto the EHR because he doesn't use it day-to-day, and as such, he can't be the one identifying what needs to change.

Second, Mr. Higginson said vendors face significant challenges with building IT systems in the way users want them. Many big EHRs were initially built as billing systems and weren't constructed to continue to build out features. Shifting focus to caring for patients is a challenge for vendors, and the financial incentive to do so isn't very strong, he said. "I struggle to see where the next innovation is going to come from," he said.

Mr. Feit discussed vendor responsibility in terms of reforming how healthcare facilities procure technology. The politics of selecting technology come into play, he said, and ripping and replacing systems can be a daunting plan for hospitals. The current model, he said, is "Once you're in, you're in, which is the opposite of promoting innovation." The politics of changing vendors is significant, and removing a platform requires "a lot of political capital…plus real capital, too," Mr. Feit said.

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