EHRs have undoubtedly already changed the way healthcare works in America, and many of these changes have been for the better. Improved workflows and care delivery, enabled through EHR technology, are in many cases key to improving both patient and public health outcomes. But in the face of increasing requirements for providers, and the ever-looming need for health systems to justify their investment, EHRs must recognize that demand is high for a product that continues to improve and keep up with the changing times.
In a 2018 survey, Deloitte found that 58% of American physicians see opportunities for improvement in clinical documentation. Unfortunately, this same survey also found that these physicians “at best [...] perceive themselves as passive participants in EHR optimization efforts and, at worst, they feel ignored.” In fact, only about one third (34%) of physicians in the survey say their organization or EHR vendor ever sought their feedback.
There’s a clear disconnect here, one which we hope health systems and EHR vendors alike will seriously consider--not only for the sake of the product itself but also because of its implications for the overall state of healthcare. But what steps can EHRs actually take to improve?
1. Documentation Automation
Documentation is such a huge burden on physicians that the Deloitte survey lists this as a primary reason for their frustration with EHRs, along with lack of interoperability. To address this, they suggest that EHRs partner with physicians and others who use the EHR, in order to understand how it is used. This can give your team insights into possible improvements in functionality, as well as possible steps toward redesign or standardization.
Deloitte suggests that new technologies like natural language processing, voice recognition, and AI may be able to automate some tasks that physicians are expected to perform but that are not clinically relevant.
2. Improving Interoperability
Interoperability, the exchange and use of health information across multiple systems, has always been an obstacle in the pursuit of value based care, and it remains a significant source of frustration with 62% of surveyed physicians hoping for improvement in this area.
Deloitte argues that while this needed change can seem unachievable, it may actually be more in reach than ever before. They detail several suggestions. Health systems that use multiple EHRs, for example, may want to consider moving to a unified EHR platform or connecting existing platforms through interface engines; APIs; health information exchange (HIE) approaches; blockchain; and/or custom solutions. Additionally, both health systems and EHR vendors can share updates with users about interoperability achievements or added functionality. Although full interoperability requires both external and internal collaboration, individual organizations can still make improvements in this area for the benefit of providers and ultimately of patients.
3. Physician Feedback and Workflow Optimization
Although documentation and interoperability were highlighted as the two top areas of concern this year, the researchers also identify opportunities for improvement in both physician feedback and workflow optimization.
Physician feedback is a woefully underused resource. As mentioned above, only about a third of physicians say they were ever asked for feedback on their EHR. Asking physicians for their feedback, though, is especially important not only for the insights it can provide, but also for the communication of organizational support.
Regarding workflows, the researchers write that understanding and analyzing current workflows is an important first step in improving them, and that EHR usage analytics, observations, and conversations with clinicians are all useful tools for accomplishing this. The researchers further suggest that an evaluation of staffing, and one-on-one EHR training for physicians, are worth considering as possible ingredients for workflow improvement. Every organization, though, will have unique needs to weigh in the course of finding their own best solution.