Getting more out of your EHR — a look to the future
The following content is sponsored by xG Health Solutions.
For better or worse, EHRs have transformed healthcare. The expectation that EHRs would improve care delivery in important ways has not yet been realized, however.
That's about to change. Danville, Pa.-based Geisinger Health System and Columbia, Md.-based healthcare solutions company xG Health Solutions have developed innovative and efficient solutions for several of the major challenges physicians face when using EHRs.
According to Geisinger CCIO Alistair Erskine, MD, and xG Health Solutions CEO Earl Steinberg, MD, MPP, the best way to overcome many of the limitations of EHRs is through software apps that operate outside of EHRs, but still talk to them.
The limitations of EHRs from physicians' perspectives
"For the most part, EHRs are electronic documentation systems and systems for performing various administrative actions — like ordering, scheduling and billing — rather than clinical decision-making support tools," says Dr. Steinberg.
One challenge physicians frequently face when using EHRs is how dispersed patient-specific data is throughout the system. As a result, physicians spend considerable time searching for information related to a particular patient. The time physicians spend searching for information in EHRs is increased because of physicians' tendency to copy and paste notes, creating layer upon layer of information that is not useful to patient care. In addition, much of the data stored in the EHR is not organized or presented to the physician in a user-friendly way.
Many of the workflows that come as part of an EHR or are programmed into an EHR by the user are not efficient or well-suited to the varying needs of different specialties, such as cardiology or endocrinology.
And current systems offer very little clinical decision support based on data analytics.
Most healthcare delivery systems lack the expertise and resources to optimize EHRs. This limitation is exacerbated by the fact that it is not easy to program changes into an EHR.
The limitations of current EHR systems are due in large part to the fact that they were designed more to support a fee-for-service model and meet regulatory and billing requirements than to create a clinically useful note, according to Dr. Erskine.
"EHRs are largely designed to promote charge capture and satisfy billing requirements more than to support high-quality, efficient care," Dr. Erskine says.
The transactional, one-patient-at-a-time nature of EHRs also presents a challenge to providers approaching care from a population health perspective. Data analytic tools are emerging that enable physicians to find data in EHRs on whole populations of patients, but few are functioning in real time, and many require data to be exported into data warehouses, analyzed and reorganized before being presented back to the physicians.
Despite their challenges and shortcomings, "EHRs will continue to play a useful role, particularly in documentation and administrative functions," says Dr. Steinberg. "Workflow facilitation and clinical decision support, however, are likely to come from software apps that are easier to program and keep up to date as science and practice changes."
How EHR companies are improving support for providers
Nonetheless, EHR companies have made great strides in recent years to better serve providers.
For example, vendors have substantially improved the advice they provide during the implementation process. They also have gotten closer to the front lines of care in order to improve their understanding of how EHRs are actually being used. These insights have enabled them to improve a number of processes.
Some vendors have even embedded specialty-specific components in their EHRs.
Additionally, more vendors realize just how mobile physicians are and are responding with tools that are adapted better to the on-the-go nature of care, according to Dr. Erskine. Advancements include cloud-based and smartphone-driven apps and tools.
The limited interoperability of EHRs and the challenges associated with extracting and sharing data remain critically important clinical and policy problems to be solved.
"Individual patients are cared for by many different providers. It's not in the patient's interest, it's not in the provider's interest and it's not in the public's interest for different EHRs to not be able to exchange data easily," says Dr. Steinberg. "Neither that limitation, nor the closed nature of many EHRs, should be tolerated."
Geisinger and xG Health: Breaking down doors
It's not uncommon to find Geisinger at the forefront of innovation — the system became one of the earliest adopters of an EHR when it implemented Epic in 1996. It's therefore not surprising that Geisinger is on the cutting edge of the development of software apps that will enhance the value clinicians get from using EHRs.
Geisinger and xG Health have worked together closely to develop software that provide solutions in areas where EHRs are not as strong, such as clinical decision support.
According to Dr. Steinberg, the software apps that Geisinger has developed and that xG Health is commercializing extract data from EHRs, reorganize it and present it to physicians in a user-friendly way. They also facilitate workflow, promote compliance with evidence-based clinical practice guidelines, integrate the results of data analyses directly into workflows and provide clinical decision support.
"The software apps Geisinger has developed save physicians time, improve quality of care, reduce the cost of care and make it easier to keep up with changes in science and clinical practice," Dr. Steinberg says.
Two of the software apps in development are slated to launch this summer as part of the suite of quality-improving, cost-reducing population health management solutions offered by xG Health. They also will be available via download from the Internet.
xG Health expects to make dozens of software apps available over the next few years. These products will be developed in partnership with Geisinger and launched in a systematic way: Solutions will be developed, tested and refined at Geisinger, and tested again at Geisinger affiliates and existing xG Health customers before being rolled out broadly.