Electronic Health Records at a Crossroads

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By Sophia Babb

Electronic health records (EHRs) are tools doctors use every day. But the records are frustrating for many doctors, and how they are used needs to change, sources told Bloomberg Law.

Shawn Griffin, an executive with Premier Inc., told Bloomberg Law that EHRs were originally designed as financial instruments to make sure that coding and billing were successful, and didn’t include much workability or interoperability in their original design.

That needs to change, said Griffin, the vice president of clinical performance improvement and applied analytics at Premier. Premier, a publicly traded health-care improvement company, pulls blinded data from EHRs to help providers understand practice patterns and opportunities for improvement.

A May blog post by a Department of Health and Human Services official noted the wide adoption of EHRs: as of 2015, 96 percent of hospitals and 78 percent of office-based doctors were using certified electronic health records. But the official, Andrew Gettinger, said usability and ease-of-reporting concerns remain. Gettinger is chief clinical officer at the Office of the National Coordinator for Health Information Technology (ONC).

What’s going on, and how can EHRs become more helpful to doctors? Bloomberg Law talked to health information technology companies and others to find out.

Pajama Time—Not a Good Thing

Griffin spoke of a concept he likes to call “pajama time.”

“Pajama time is when doctors have come home and finished their work day, but they haven’t finished their documentation day. They have to catch up on documentation that they couldn’t do during their work hours, which greatly contributes to doctor burnout,” Griffin told Bloomberg Law.

“It’s a sign that the tools used during the work day aren’t as efficient as they need to be,” Griffin said. “EHRs have become increasingly burdensome, and they have become an impediment to care, not a facilitator of care.”

More Training, More Satisfaction

A survey by KLAS, a market research firm based in Utah that conducts surveys on EHR satisfaction, showed that the more training physicians get on EHRs and how to personalize them, the more satisfied the doctors are.

Epic Systems Corp., which held 25.8 percent of the health-care information technology market in 2016, designed a “Physician Builder Program” to bridge the gap between doctors and EHR implementation.

Janet Campbell, vice president of technological evangelism at Epic, said the program “empowers physicians.”

“It teaches physicians how to safely customize their EHR to best fit their goals and the goals of the people working right next to them,” Campbell told Bloomberg Law. “Physicians understand their workflows way better than someone will in IT, so when you empower them with the ability to tweak things to their satisfaction, they don’t have to wait for their organization to make large scale decisions.”

Epic is a privately held company based in Verona, Wis. Publicly traded Cerner Corp. fell just behind Epic in 2016, with 24.6 percent of the market share.

Market share information was provided by George Hill, equity research analyst from RBC Capital Markets.

Christine Parent, associate vice president of marketing at Medical Information Technology, Inc. (MEDITECH), said she often hears physicians saying they want more personalization for their workflow based on their specialty or practice. MEDITECH took 16.6 percent of the health-care information technology market in 2016, and is based in Westwood, Mass.

“It’s always different from physician to physician, so we want to work elbow to elbow with physicians to make sure their tools are embedded. The tools are good, but the implementation process helps us make sure that their EHRs are being utilized as well as they can [be],” Parent told Bloomberg Law. MEDITECH often does this through its Clinical Leadership Preparedness Program, where they work with physicians, nurses, and pharmacists to lay out the workflow process.

“It really has to become a multidisciplinary discussion,” Parent said.

There’s been a push for students to get more training on EHRs, too. The American Medical Association called for students to have more exposure, access, and training on electronic health records in a new policy adopted in mid-June.

Interoperability

Blain Newton, executive vice president of Healthcare Information and Management Systems Society (HIMSS) Analytics, said the average hospital has to interact with 16 EHR systems across their care network. The systems often are written with different coding languages, and it’s technologically difficult to communicate from machine to machine, Newton told Bloomberg Law. This lack of interoperability between systems leads to incomplete patient health records and more work for each doctor.

But vendors like Epic and Cerner are coming up with solutions for interoperability, Newton said. For example, Epic’s CareEverywhere platform allows doctors and nurses to electronically exchange patient medical information from Epic-to-Epic EHR systems across hospitals.

The government is also stepping in, Newton said. “We’re seeing significant movement to solve interoperability within the Centers for Medicare & Medicaid Services. They’re putting renewed focus on it.”

HIMSS Analytics, a subsidiary owned by HIMSS, is a health IT research and advisory firm that provides guidance on electronic health record adoption to hospitals and clinical practices.

Lackluster Implementation

According to former federal health IT official Rebecca Freeman, many inefficiencies can be solved by better training on customization and implementation. Freeman was the chief nursing officer at the ONC from 2015 to 2017.

“Lack of usability is often self-inflicted. It comes down to customization and a lack of standard processes. Physicians often become upset that they have to click 42 times to get to what they need to see, but that can be changed,” Freeman said.

Freeman’s mention of 42 clicks is relevant to the frustration with EHRs; a 2015 study showed doctors make 192 clicks during a session.

Freeman said those extra clicks sometimes come from regulatory measures, or more likely, they come from the decisions that were made when the EHR was implemented. And to fix that, EHR users have to reverse-engineer their system.

“For example, you might have 10 people in one specialty and all 10 people want to use different systems, note templates, and workflows. This makes a really complicated system after you cater to every user and then short them on training,” Freeman said. “To solve that, you have to tease out what is truly regulatory, clean up what’s there because of a decision made years ago, and then agree on standardizing the EHRs within your facility.”

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