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Electronic Health Records, Issues and Solutions

Electronic Health Records: a laptop with a stethoscope and paper records nearby

The healthcare industry has been making progress for years towards better treatment outcomes and the overall quality of medical services. Electronic Health Records (EHR), or Electronic Medical Records (EMR) as they are sometimes called, is a key player in achieving these improvements. There are plenty of advantages of EHRs in the clinical setting and they are well-known among healthcare providers. Let us take a closer look at how we can benefit from these systems.

The current state of Electronic Health Records Systems

In the 2012 edition of the Physician Sentiment Index, 81% of doctors agreed that EHRs streamline access to clinical data. More than two-thirds believed an EHR can really optimize patient care. 31% of survey respondents had a “very favorable” opinion of Electronic Health Records, 38% had a “somewhat favorable” one, 14% had stayed neutral, and only 18% had an unfavorable opinion. Moreover, 68% felt that EHRs enhance healthcare quality.

However, a year later came the Physician Sentiment Index “[showing] industry confusion, a grim outlook on the future, a failing among EHRs…”. According to this year’s Sage Growth Partners study, 64% of medical specialists assert that EHRs failed to bring lots of critical value-based care tools. Around 66% of respondents stated that EHRs had failed to bring promised clinician or patient satisfaction (60% and 64%, accordingly) or provide better population health management tools (64%).

So what are the reasons for such dissatisfaction?

Drawbacks of the Existing EHRs:

Time-consuming work

Doctors spend more time working with their EHR systems than communicating with patients during visits, Family Medicine research says. Researchers deeply studied family physician residents and patients considering 982 hospital visits, related to 10 Residency Research Network of Texas (RRNeT) residencies during one month in 2015.

It was defined that the average visit duration was 35.8 minutes. About 2.9 minutes of the visit was devoted to the doctor’s preliminary work before meeting a patient. Then 2 minutes were spent working in the EHR during the visit. In addition, a physician spent 6.9 minutes on EHR work outside working hours. Apart from that, the average visit comprised 7.5 minutes which weren’t devoted to communication with patients, most of this time was spent on the EHR. Consequently, providers spend about 18.6 minutes working in the EHR while communicating with patients takes about 16.5 minutes.

Small medical practices can’t receive data properly

Most small medical practices are not able to receive the needed data through their EHR. Apart from that, lots of their historical data, as well as plenty of new reports, is still in unstructured form as, for example, scanned paper reports. This means they are not translated into discrete data fields in the EHR.

A 2016 report from the U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention (CDC) revealed that in 2015 almost four out of five (77.9%) office-based doctors were utilizing EHRs. However, just a third of doctors had utilized an Electronic Health Records system to either forward, obtain, integrate, or seek patient health data and only 8.7% of doctors utilized their EHR system for all four of those activities.

Lack of EHR data interoperability

The inability to exchange data seamlessly between hospitals is a common present challenge, although the goal of EHR implementation was to upgrade the management of patient data.

Today, the exchange of patient data is problematic since there are plenty of different EHR systems existing in the industry. Yet, they don’t communicate with each other properly. Because of inefficient transfer of information, physicians have to re-gather patient history, reorder lab tests and make medical decisions having incomplete data which leads to unwanted delays, wasted funds, and insufficient patient care.

Improving existing Electronic Health Records Systems

Reducing the work with EHRs

In order to rise direct clinical face time with patients, it’s possible to switch to advanced team-based care where the doctors work with a stable team of two or three clinical assistants. This model implies that one of the clinical assistants provides in-room support during the patient visit, performing real-time information retrieval, visit note documentation and pending orders.

Enabling small medical practices to mine patient data in EHRs

Health systems, groups of independent providers, contributors and medical institutions have to band themselves together to exchange information with each other. They also have to reveal the sources in order to translate that information, lower cost and attract patients to use healthcare services.

The way to do that is to create or join associations like clinically integrated networks, Accountable Care Organizations (ACOs) or other types of joint ventures. There is a necessity to train data analysts and doctors to use the principles of informatics and statistics in order to obtain the needed information. This will need focused leadership and the consent to share this data seamlessly.

Achieving EHR interoperability

By calculations of Health Care Transformation Task Force, currently, there are 923 ACOs that cover about 32.4 million patients. Today, these groups are extremely common and they are going to transform the industry. What about considering an ACO working in a metropolis with lots of independent primary care providers, a number of clinics and other healthcare providers?

In the absence of a ubiquitous implementation of the same EHR platform or experiencing long and costly integration projects, this ACO can use cloud-based platform resources to enable all the participants to exchange structured medical records and unstructured patient data between each other in any existing EHR.

In that case, healthcare providers would have an opportunity to share information with simple and affordable IT configuration of their EHR system – not deep integration – and open directions of information exchange with other providers to do their job efficiently.

We have to face the truth that making an ideal consolidated patient record, via deep and costly enterprise integration, is not a realistic idea to bring to life in the near future. However, enabling healthcare providers with actionable information on a par with incentives to improve quality and reduce the cost, is an achievable goal.