Though the communication systems between healthcare providers has been dramatically improved and streamlined since the widespread adoption of electronic health record systems (EHR) began, the interoperability between those separate systems still has gaps. Improved interoperability would close those gaps further, giving a better and more efficient experience for everybody. The ONC report shows that the gaps are indeed getting smaller, but that there is still much room for improvement.
Mirroring similar patterns observed in 2012, the ONC quote the following statistics:
18% of patients have to provide medical histories again because the provider they are sitting in front of had not obtained records from a previous provider.
7% had to provide medical histories again due to missing or lost charts
18% take (in paper form) the results of medical exams or tests to the next doctor they see
11% wait longer than it is reasonable to expect for their test results
6% had to redo tests or procedures due missing or expired results
Much of the above could be due to disparate electronic systems being technically unable to exchange data. If this were not the case, i.e. if interoperability between systems were in place and effective, many of those numbers would be much lower, in some cases even eliminated entirely.
As interoperability improvements increase and the pace of development quickens, it is to be hoped that the time will shortly come where the gaps we see today will be closed, permanently.
Using an EHR system to automate clinical quality measure (CQM) reporting has been shown to reduce reporting time required for one measure set alone by up to 50 percent, according to a study published by Kaiser Permanente in the Journal of the American Medical Informatics Association.
Jed Weissberg, MD and senior vice president of Hospitals, Quality and Care Delivery Excellence at Kaiser Permanente, is quoted as saying "With an increased focus on transparency in the health care industry, we are seeing significant growth in the number of public reporting initiatives, and automated quality reporting allows us to keep up with these initiatives without adding to high overhead costs. For the six measures studied in this paper, we were able to extract between 43 percent and 100 percent of the elements needed for the measures. An added benefit of automated reporting of quality measures is that some data becomes available real-time, further enabling us to improve care in an expedited manner."
Reporting regularly on a set of over 50 internally standardized metrics, the study results are likely to be particularly accurate. The measured metrics for this study were primarily taken from emergency room data and patient facing situations such as immunizations. The improved efficiencies noted in one area alone (surgical care) were seen to reduce reporting time by literally 50%. Such savings, across the board, would offer great significance to practices and patients across all specialties, bringing with them concomitant decreases in expense and time, and increases in patient handling and practice throughput. Everybody wins.
The study further noted that increased, faster reporting levels allow faster and more accurate trend analysis and diagnosis, with the following consideration: The primary function of many electronic health record systems is to capture and store clinical data to support care delivery; therefore much of the quality reporting supported by a generic EHR is not fully automated.
The broad findings of the study clearly show that EHR systems can be of immense benefit in a hospital environment. These findings are equally encouraging for practitioners in other areas and specialties of medicine, including small practices and clinics where similar benefits are sure to be reaped.
Part Two: H is for Health
In this second article we cover the second pillar of EHR: Health. The primary purpose of a practice, hospital, or treatment facility is to treat the sick. Whether they are suffering from strep throat, a broken leg, a serious behavioral health issue or an addiction, the end goal is the same. Improved outcomes and better quality of life. Electronic Health Record systems (EHR) help practitioners and clinicians achieve more, more efficiently, and improve patient outcomes significantly. Well used, the EHR becomes an extension of the organization, a data crunching analytic tool which can predict outcomes, raise alarms, mark milestones and monitor progress. Think of them as an impartial consultant, but better.
Better, because they don't argue with the doctor of record. They have no opinion, no pride, no agenda (beyond what they hold in their scheduling system). They offer fact-based insights and treatment overviews, collate seemingly unconnected data, offer conclusions which may not be obvious, along with suggestions for ways forward. If thinking of them as an unpaid consultant goes against the grain, think of them instead as everybody's intern. Unfailing, untiring, unambitious interns that work around the clock and that make no mistakes.
The Health of your patients could hardly be in better hands.
The primary focus of health care is the health of the patients. With that focus, whatever achieves the best medical outcome is the best tool to use. Whether that tool is a scalpel, or a prescription pad, or an EHR. When reduced to basics, an EHR is simply a tool, much maligned and undervalued by many. EHR is a tool designed to help improve the health of patients and the workflow of practitioners. Use it effectively, and see increased patient health outcomes across the board, as evidenced by an increasing number of statistical surveys and reports. Health, the primary purpose of health care, is also the primary purpose of the EHR. The two go hand in hand. Health, the second word in Electronic Health Records, is very much something an EHR can help you work with, and which will help your patients find a better quality of life, faster.
In the third article in this series, we will discuss the third pillar of EHR. R, for records.
Electronic Health Record (EHR) systems will soon be mandatory. Many don't like that. But since it will be a requirement, we should learn to embrace it. Here are five benefits.
Collating data into daily, weekly, or monthly reports in a manual system is time-consuming and wasteful. With an EHR, simply enter Start and End dates and hit a button. The reports print out while you go to lunch.
Custom templates give standardized output, free from typos and other errors, while automated text can type four perfectly punctuated paragraphs with one key press. That's kind of hard to beat.
Keep your paper in the printer, rather than the shredder. An EHR is always accessible so you have no need to print. You can call data up on-screen at any time, saving on paper, toner cartridges and waste.
See points one through four and you will see that the overall time saved by staff and clinicians can be redirected into other channels. You are already working smarter, not harder.
Ever wondered about your patient base? Or staff workloads? An EHR can give you all the stats you could ever need, pulling data straight from those automated reports mentioned earlier. Highly useful when planning for the future, or just seeing what's happening right now.
There are many more benefits which even a cursory thought process can find. If you have not yet moved to an EHR for whatever reason, it is time to think about getting started down that road. Don't resist it, embrace it, and you may grow to find that this decision was one of the best choices you could have made for securing your future.
Part Three: R is for Records
The third and final pillar of EHR is of course Records. Few can deny the benefits to be gained from an Electronic Health Record (EHR) system. No paper-based system can simultaneously handle many thousands of individual medical records, monitor medication programs, and remind you of upcoming tasks and appointments. Though many object to 'working for the machine', the truth is that prior to EHR they were working just as hard, if not harder, for the 'paper monster'. Late nights and hours spent digging through archives to find missing folders are things largely of the past, and that is in truth where they belong.
If you need to access a patient’s electronic medical record, you don't have to phone someone and wait, or walk across the facility to start opening filing cabinets. A few key presses now gives you have the data you need for the task at hand.
The thing to remember is this. All that initial data entry (that nobody enjoys), simply saves time later. It's a front-loaded process. OK, so you believe that you spend more time entering data into the EHR than you did with the paper system before it? Well, consider this. An EHR will keep asking for data until it has ALL the data it needs, based on the situation and the specifics of that patient. While that may mean a few more minutes now, it may mean an hour saved later. It also means that electronic health records are commonly both more accurate and more complete than their paper counterparts ever were.
There may be more data to enter, but any front end delay is worth it, because it eliminates situations where patient records are incomplete for the next person, which if you think about it saves everybody time. And of course, if you are that next person, you will be very grateful that the data you need is there on demand, accurate and available without wasting an hour of your time finding a folder at a reception desk or nurses station, only to find that the specific data you need just is not there.
An EHR does not let you skip, because patients may suffer if that happens. And EHR does not forget. And an EHR does not allow omissions of relevant data. Records are something that EHR's are very good at. Which saves time, and again, it saves lives.
If you have enjoyed this series of brief articles and find yourself considering the possibility of upgrading to an EHR solution of your own, please consider us. Our experienced team can answer your questions and work with your organization to achieve the best, fastest and most effective implementation for you. We hope to hear from you. Please continue to check back for future articles and follow our blog. Thanks for reading.
Part One: E is for Electronic.
Electronic Health Record systems have three strengths, all of which are built right in to the name. Electronic systems have faultless memories which can be backed up, retrieved at will and sent around the world in a split second. There is no other method that can compare to this level of utility. Data held in paper-based systems is inherently subject to fire, flood, loss, and of course human error.
Electronic systems have advantages which neatly sidestep these problems. Cloud services and automatic backup systems mean your data exists in multiple locations, making it far less susceptible to disaster, while human error is reduced by data input validation, and the stubborn refusal of the EHR to let users continue until they have correctly completed all required entry fields and inputs.
Perception is everything. Many have reported feeling frustrated by the constraints imposed on them by inflexible electronic systems. Many are also angry that their beloved freeform data entry they used with the paper-based systems have been taken from them. The reality is, with freedom comes responsibility, and with responsibility, the possibility of error. "I'll finish the paperwork later" is a phrase that has preceded many tragedies, and so it should be consigned to history. Electronic systems are insistent: You will enter the data now. And that is a great thing. It protects the patient, and it protects the practitioner, and it ensures the data is present for the next person to look at the file. That saves time, and it saves lives.
Electronic health record systems are a safety net, a guardian and a patient educator all rolled in to one. Rather than rage against the machine, embrace it. Use it. Work smart, get more done and do it more accurately than ever before, with your new Electronic friend, the EHR.
Electronic is the first of the three words in EHR. In our second article, we will look at the second: Health.
Paper workflows for medicine are being replaced. Few doctors carry paper folders around with them anymore. In January 2015 medical records should all be electronic, by law. Where will this path end?
A recent article by Janet Woodcock, M.D. and Director of the FDA Center for Drug Evaluation and Research, discusses the increasing amount of medical data being shared over the Internet between increasingly large organizations. Woodcock rightly foresees a time when this data will be aggregated and used to develop new treatments, or new drug therapies. Many private organizations and Big Pharma are already developing their own strategies along these lines, for profit. The idea is not new. The technology which will allow this to happen, though? Ah well. That is.
With improved interoperability, more HIE’s, centralized health plans, higher data input rates and growing EHR adoption, the volume of data available is growing exponentially. All this medical data is being linked, shared, collate, sifted and analyzed, faster and more accurately every day between increasing numbers of stakeholders. We live in exciting times. The challenge will be in storing it and, beyond that, making sense of it. And then, what?
When the dream of full connectivity arrives, sometime in the next hundred years (or five, if you're optimistic), the possibilities will be staggering.
Envision a world where computers identify a pandemic within 24 hours of an outbreak and the CDC can effectively contain it. Or, perhaps, a world where medicines can be transported rapidly to hot-spots, finally eradicating the last vestiges of diseases like polio or smallpox? Or one where health insurance premiums are index-linked to highly accurate statistical national averages? Hey, I didn't say the possibilities would all be idealistic, or good. But the number of possibilities is growing. That’s the point.
The difficulties of technological evolution are widely written about in the media every day. Less is written about the potential, the benefits which may eventually arise from the current upheavals in medical technology.
Only a few years ago the Internet did not exist. When it arrived, there were many dire predictions of the end of the world. It did not happen. Though things changed, we are still here. The technology is evolving at an ever faster rate, forcing us to grow along with it and allowing us to foresee possibilities that were until now unrealistic and visionary. Now, those possibilities are tangible, within our grasp.
And what of next year? And the year after that? Wait and see. I predict wonders.