Electronic Health Record (EHR) systems are fundamental and necessary for any successful health system. They generate orders and aggregate and trend results; they assemble nursing and provider notes that encompass the patient story within and across episodes of care; they capture charges and automate the revenue cycle management functions. Most EHRs now also have a patient-facing interface where patients can communicate with their providers, view test results and schedule visits.
Initially designed and conceived of as a primarily transactional system, EHRs now serve many health system operations well. But, they are very complex, multi-purpose tools built to serve a wide range of types of health system and healthcare provider users. Arguably, with that complexity, they aren’t as sophisticated or nearly as intuitive as your favorite website or app.
While health systems strive to improve the usability, ease and intuitiveness, add functionality and transform the way the EHR is used to deliver better care, there are several factors that are getting in the way:
• All EHRs and EHR versions have different levels of functionality. While healthcare IT has lots of standards, there are highly variable interpretations and implementations of those standards. If you have seen one EHR, you have seen one EHR.
• Many health systems and providers are still struggling with simply implementing basic functionality because of cost, resources and/or competing priorities.
• With different levels of maturity of functionality and/or adoption, the lowest common denominator between EHRs and health systems often defaults to a very basic level of functionality – making consistent and advanced integration difficult.
• Healthcare, as an industry, is undergoing significant change resulting in mergers, acquisitions and non-traditional partnerships, all of which may require EHR consolidation and/ or implementation efforts. These efforts often take priority over implementing advanced, innovative functionality.
• EHRs are highly proprietary, and it is not necessarily in their financial best interest to facilitate interoperability with other companies.
"Many organizations that want to innovate don’t have the resources to design and build EHR-based solutions themselves, so they are beholden to the EHR vendor building and releasing solutions"
Bottom line, there is still quite a bit of basic blocking and tackling going on in healthcare IT. So, given this reality, what are those health systems focused on transformation and innovation to do?
There are a couple of models that have emerged:
1. Innovate around the EHR
There are many organizations that have setup innovation centers where new ways of working are ideated, designed and implemented. Often, the integration with the EHR is not considered, or it is considered but the design and build of the EHR functionality to support the new processes is too difficult. Solutions are then built outside and around the EHR. While this may be a great way of generating and trying out new ideas, the fact that the new process and tools are not integrated with the EHR, and therefore the provider workflow, may limit usability and scalability, and ultimately, sustainability. In many cases, these ideas end up dying in the innovation lab or after a limited pilot.
2. Innovate and implement solutions in the EHR when the EHR vendor releases the functionality
Many organizations that want to innovate don’t have the resources to design and build EHR-based solutions themselves, so they are beholden to the EHR vendor building and releasing new, more advanced solutions. While this works in the long run, the release cycle for the new functionality may not meet organizational timeframes, and good ideas may have to be deferred or abandoned completely.
3. Innovate, use the EHR vendor solution when possible, and integrate with innovative third-party solutions as well
If a health system desires to innovate, and is convinced that EHR integration is a must-have, a hybrid model exists where the health system can rely on the EHR vendor for advanced solutions as the preferred path for innovating. But, where that option doesn’t exist, the health system can partner with innovative third-party vendors and integrate the solution with the EHR.
With this third model, the innovation agenda can be moved forward in a timelier manner and in a way that is scalable, and hopefully, sustainable. If a health system does choose to move forward in this fashion, there are several factors to consider:
• Stay current with the EHR releases and ensure there is a process for turning on new functionality when it is released by the vendor. This is a foundational element. If the EHR isn’t current, it is going to be difficult, if not impossible, to execute.
• Focus on how to get data in and out of the EHR effectively. This can mean HL7 interfaces, FHIR, or vendor-supported web services and APIs. When integrating with third-party vendors, use standard integration technologies and have internal staff members who understand the technologies. Avoid custom programming, unless all other options have been exhausted.
• Identify physicians and nurses who are subject matter experts and familiar enough with the EHR to speak to what innovations are needed to improve the care delivery process. Pair up engineers with the clinicians throughout the entire process, ideally before the first line of code is written, to ensure the innovations are truly going to work in existing and new clinical workflows. Ensure that the integration between the EHR and the third-party tool is intuitive and seamless. In a perfect world, the clinicians don’t even know the difference between the EHR and third-party tool – it just works.
Implementing and maintaining EHRs is difficult. Innovating and integrating new tools and functionality into the EHR is even more difficult. But, it can be and has been done and is essential if the EHR is to be truly functional and intuitive. Understanding what the organization’s goals are around innovation, tolerance for change and what the internal IT staff core competencies are will help determine what model of innovation and EHR integration will work best.