It's time to expect more from EHRs

The first electronic medical record (EMR) was developed in 1972 by the Regenstreif Institute and was viewed as a major advancement in medical practice.

Electronic records evolved beyond capturing patient history to a more comprehensive view of a patient’s health and now are known as electronic health records (EHRs). They were seen as a critical tool to improve the quality and efficiency of clinical care such that legislation was introduced to encourage their adoption. The Health Information Technology for Economic and Clinical Health (HITECH) Act, a component of the American Recovery and Reinvestment Act of 2009 (ARRA), provided incentives and disincentives that led to wide-scale adoption and use of EHRs.

As of 2021, 88% of office-based physicians and essentially all acute-care hospitals were using EHRs. U.S. EHR expenditures grew an average of 5.4% annually from 2015 to 2019, totaling $14.5 billion in 2019. And spending growth is forecast to reach $19.9 billion in 2024, $9.9 billion of that for hospital EHRs.

Yet, EHRs are a source of growing frustration in several areas. One concern is the burden they have created for clinicians. In a Stanford Medicine poll, 71% of physicians reported that EHRs contribute to burnout, and 59% think EHRs need a complete overhaul. Moreover, clinician burnout already costs the U.S. health care system more than $4.6 billion annually. In 2020, the U.S. Department of Health and Human Services (HHS) released an overarching strategy to reduce clinician burden associated with entering information into EHRs, meeting regulatory requirements and improving EHR ease of use.

Over the decades, health care organizations have invested heavily in technology that has not delivered its full expected value, making the current environment ripe for change. Health systems, hospitals, and providers are all challenged by five common pain points EHRs create. As organizations look ahead, there are proven approaches to addressing these pain points.

High costs with questionable returns

As evidenced by the historical and projected growth in EHR expenditures noted above, health care providers have invested billions in them along with countless hours, encouraged by federal policies and regulations, yet realizing real return on their investment remains a challenge.

Many health care organizations feel intimidated by the time, effort and money needed to complete an EHR conversion. Narrowing margins following the COVID-19 pandemic have forced them to carefully weigh the value of every health IT dollar spent. While many recognize the potential of EHRs to improve clinical and financial outcomes, the current transaction-based EHR models often fail to accomplish those goals.

An alternative is a system-as-a-service (SYaaS) subscription model that includes all hardware, software, and ongoing support services. This approach centralizes all implementation, optimization, and system monitoring services to manage reliability and performance.

Health systems using a SYaaS model have a predictable cost that includes all current and future interfaces and continuous IT and implementation training support, reducing labor costs and significantly lowering the total cost of ownership. With ongoing IT support and lower overall costs, health care organizations can focus on optimizing care processes and workflows to achieve improved clinical and financial outcomes.

Interoperability challenges

Interoperability is at the heart of much of the frustration with EHRs, from the inability to easily share patient data to suspected data blocking. It’s a problem that makes day-to-day life for clinicians harder. Seven out of 10 PCPs (67%) think solving interoperability deficiencies should be the top priority for EHRs in the next decade, according to a Stanford Medicine poll.

Many initiatives seek to tackle the issue. The U.S. government has been instrumental in pushing for advancement through several initiatives.

Recently, the Office of the National Coordinator for Health Information Technology (ONC) released a notice of proposed rulemaking, “Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing.”

This rule seeks to build upon progress made through the Trusted Exchange Framework and Common Agreement (TEFCA) and other initiatives to support patients and providers across the care continuum. It includes proposals for electronic movement of health information, new data exchange standards, electronic case reporting for both public health and emergency responses, and algorithm transparency for certified technology.

Health systems have options for EHRs that embrace interoperability standards, but EHRs need to do more than just keep pace with advancing standards, such as the Fast Health Care Interoperability Resources (FHIR) Application Programming Interface (API). They also need an adaptable and scalable database to incorporate workflows and functionality that enable organizations to integrate care processes across all care settings, making care more efficient and reducing the burden on clinicians.

Clinician burnout

The key reason that EHRs are named as a contributor to clinician burnout is time. Clinicians express frustration that they spend nearly twice as much time doing manual, EHR-related tasks as they spend with patients. Hospital-based physicians reported spending 37 minutes on behalf of each patient – 25 of which was spent in the EHR, according to a Stanford Medicine poll. And, by some estimates, 75% of health care workers may leave the profession by 2025, making it more urgent for health care organizations to seek higher performing solutions.

A recent JAMA Network editorial states that clinicians are burdened with EHRs that prioritize administrative, financial, and regulatory needs over clinical workflow. Clinicians and their patients, it says, deserve a “patient-centered, technology-enhanced health care ecosystem that is designed to significantly improve outcomes at a lower cost.”

When EHRs take a human-centered, clinician-first design approach, offering intuitive workflows and a seamless user interface, the EHR can stop being the focus of clinicians’ days, and instead support them as they provide care to patients, with documentation resulting as a natural by-product of patient care interactions.

For example, with human-centered design and advanced integrations, nurses working with monitored patients report saving as much as 15 to 20 minutes per patient per shift. It’s just one example of how giving clinicians measurable efficiency gains can have a material, positive impact that reduces burnout.

Lack of reliability and downtime

The news is full of headlines about health care organizations experiencing system unavailability, increasingly due to cyberattacks. In 2022, U.S. health care organizations suffered an average of 1,410 weekly cyberattacks per organization, up 86% from 2021.

But cyberattacks are just one cause. Most EHRs require planned downtime for system maintenance and upgrades. And almost all organizations, 96% in one study, reported at least one unplanned EHR system downtime, while another study found that 70% of organizations experienced at least one unplanned downtime lasting eight hours or more.

In response to the growing threat, the U.S. Department of Health and Human Services recently released its Hospital Cyber Resiliency Initiative Landscape Analysis and new resources for health care organizations intended to help improve cybersecurity. EHRs built upon modern foundational architectures that focus on security and reliability, such as those designed to meet stringent U.S. government security requirements, can deliver the performance and data protection health systems require, while eliminating both scheduled and unscheduled downtime.

Long implementation times

Because of their inherent complexity, EHR implementation projects for hospitals are a heavy lift for staff across the organization and often require a year or more to complete. The implementation involves a wide range of areas, including clinical functions, billing processes, regulatory compliance, quality measuring tools, and more. The time and resources required to replace an EHR hinders many organizations from considering a change, even if their current system doesn’t meet their needs.

An implementation alternative that emphasizes a partnership approach and includes required resources can accelerate the implementation timeline while alleviating the burden on facility resources, resulting in a successful implementation with high user adoption and satisfaction.

For example, in the inpatient environment, the implementation process should ensure that hospitals do not have to decrease patient census during go-live, thus preventing a reduction in productivity and lost revenue. In addition, the implementation process should not require the organization to add staff, but include experienced resources that extend their team, taking responsibility for building, maintaining, training, optimizing – everything needed to deliver an effective implementation.

With dedicated subject matter experts tasked with tailoring the EHR to the organization’s policies, procedures, and workflows implementations can be completed in months rather than years. For example, a large national health system brought 36 hospitals live on a new EHR in just 18 months at a pace of two hospitals each month.

Disrupting the status quo

With health care organizations’ heavy investments in EHRs, it’s possible for them to realize more return on those investments. It’s time for disruption from EHRs that use proven technology to make costs reasonable and predictable, shorten the time to value, leverage interoperability while improving security and reliability, and focus on making work easier for clinicians.

Ultimately, this will shift the focus to clinician wellness and bringing the joy back to their work while enabling organizations to achieve better clinical and financial outcomes.

Holly Urban is vice president of clinical product design for CliniComp.