Benefits Of EHR & How To Overcome Potential Challenges
Electronic Health Record (EHR) systems are a big talking point at the moment within the healthcare industry. Many hospitals and medical institutions are making the move from paper records to electronic notes, changing the way healthcare administration is handled for good. Many experts and professionals are advocates of the move, however with change there is always challenge. This month in Healthcare Global, we look at the advantages and challenges of adopting EHR and speak to a number of experts about how to overcome these challenges and optimise EHR for the benefit of both patients and professionals.
The healthcare industry has been relatively slow on the uptake when it comes to digitization – people the world over have been using the internet in their day to day lives, and yet they still receive hand written prescriptions and often cannot contact their doctor via email or even schedule an appointment without speaking to a receptionist. Patient confidentiality and fear of losing information has played a big part in the hesitant uptake, however there are now systems in place, which make EHRs far more secure than their traditional paper counterparts.
EHR systems have the potential to transform the healthcare industry. They could revitalise a process, which at the moment is largely paper-based, into one that utilizes clinical and other pieces of information to assist providers in delivering higher quality care to patients. EHRs can be exceptionally useful for medical practitioners and institutions, not only in providing a better, more efficient level of healthcare but also by providing certain functionalities associated with error reduction and cost containment.
How Exactly Do EHRs Improve Healthcare?
EHRs are defined as a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports. Some of the basic benefits associated with EHRs include being able to easily access computerized records and the elimination of poor penmanship, which has historically plagued the medical chart. EHR systems can include many potential capabilities, but three particular functionalities hold great promise in improving the quality of care and reducing costs at the health care system level: clinical decision support (CDS) tools, computerized physician order entry (CPOE) systems, and health information exchange (HIE).
Clinical Decision Support
A CDS system assists the provider in making decisions with regard to patient care. Some functionalities of a CDS system include providing the latest information about a drug, cross-referencing a patient allergy to a medication, and alerts for drug interactions and other potential patient issues that are flagged by the computer. With the continuous growth of medical knowledge, each of these functionalities provides a means for care to be delivered in a much safer and more efficient manner.
Computerized Physician Order Entry
CPOE systems allow providers to enter orders for example, for drugs, laboratory tests, radiology, and physical therapy, into a computer rather than submitting a paper order. Computerization of this process eliminates potentially harmful medical errors caused by poor penmanship of physicians. It also makes the ordering process more efficient.
"EHRs benefits include the easy access of computerized records and the elimination of poor penmanship"
Health Information Exchange
One of the most beneficial elements of EHRs if not the most beneficial is HIE (Health Information Exchange. Once health data is available electronically to providers, EHRs facilitate the sharing of patient information through HIE. HIE is the process of sharing patient-level electronic health information between different organizations and can create many efficiencies in the delivery of health care. By allowing for the secure and potentially real-time sharing of patient information, HIE can reduce costly redundant tests that are ordered because one provider does not have access to the clinical information stored at another provider’s location. It can also be beneficial insofar as doctors can have almost immediate access to patients notes in an emergency situation, allowing them to provide the right medical care quickly and efficiently.
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The Challenges Associated With EHR
Despite the growth in uptake and the wide spread discussions about the benefits of various EHR functionalities, some professionals have identified potential disadvantages associated with the technology. Financial issues, changes in workflow, temporary loss of productivity associated with EHR adoption, privacy and security concerns, and several unintended consequences have all been bought to the table by experts in the medical profession.
Finance And Maintenance
Financial issues, including adoption and implementation costs, on-going maintenance costs, loss of revenue associated with temporary loss of productivity, and declines in revenue, present a disincentive for hospitals and physicians to adopt and implement an EHR. EHR adoption and implementation costs include purchasing and installing hardware and software, converting paper charts to electronic ones, and training end-users. That being said, as EHR technologies have become more commonplace over the past decade, the initial cost of systems has come down dramatically, making EHR adoption much more viable. It is important that medical institutions take the time to install the right EHR system for their ecosystem, they also need to take the time early on to train employees and to introduce the benefits associated with implementing the system.
The maintenance cost of an EHR can also be costly. Hardware must be replaced and software must be upgraded on a regular basis. In addition, providers must have on-going training and support for the end-users of an EHR. Having said this however, the efficiencies bought about by adopting such software can dramatically impact the bottom line of any institution, making the pill easier to swallow. EHR not only has an impact on efficiencies when it comes to patient care, it can also help with making hospitals supply chains more efficient, a factor that could save medical institutions millions considering the medical supply chain can account for more that 50 percent of a systems costing per annum.
Another potential drawback of EHRs is the risk of patient privacy violations, which is an increasing concern for patients due to the increasing amount of health information exchanged electronically. Although privacy will likely continue to be a concern for patients, many steps are being taken by policymakers and individual organizations to ensure that EHRs comply with the strict laws and regulations intended to ensure the privacy of clinical information.
Finally EHRs may cause several unintended consequences, such as increased medical errors, negative emotions, changes in power structure, and overdependence on technology. End-users of an EHR may experience strong emotional responses as they struggle to adapt to new technology and disruptions in their workflow. Changes in the power structure of an organization may also occur due to the implementation of an EHR. For example, a physician may lose his or her autonomy in making patient decisions because an EHR blocks the ordering of certain tests or medications. Overdependence on technology may also become an issue for providers as they become more reliant upon it. Organizations should ensure that basic medical care can still be provided in the absence of technology, especially in times when the downtime of the system may be critical. Although there are many unintended consequences of EHRs, when balancing the advantages and disadvantages of these systems, they are beneficial, they just need to be implemented and introduced correctly for the ecosystem you are working within. Make sure that all employees have the opportunity to discuss potential problems and changes and ensure you have a provider that can facilitate those changes should you need to make them.
How UiPath robots are helping with the NHS backlog
The COVID-19 pandemic has caused many hospitals to have logistical nightmares, as backlogs of surgeries built up as a result of cancellations. The BMJ has estimated it will take the UK's National Health Service (NHS) a year and a half to recover.
However software robots can help, by automating computer-based processes such as replenishing inventory, managing patient bookings, and digitising patient files. Mark O’Connor, Public Sector Director for Ireland at UiPath, tells us how they deployed robots at Mater Hospital in Dublin, saving clinicians valuable time.
When Did Mater Hospital implement the software robots - was it specifically to address the challenges of the pandemic?
The need for automation at Mater Hospital pre-existed the pandemic but it was the onset of COVID-19 that got the team to turn to the technology and start introducing software robots into the workflow of doctors and nurses.
The pandemic placed an increased administrative strain on the Infection Prevention and Control (IPC) department at Mater Hospital in Dublin. To combat the problem and ensure that nurses could spend more time with their patients and less time on admin, the IPC deployed its first software robots in March 2020.
The IPC at Mater plans to continue using robots to manage data around drug resistant microbes such as MRSA once the COVID-19 crisis subsides.
What tasks do they perform?
In the IPC at Mater Hospital, software robots have taken the task of reporting COVID-19 test results. Pre-automation, the process created during the 2003 SARS outbreak required a clinician to log into the laboratory system, extract a disease code and then manually enter the results into a data platform. This was hugely time consuming, taking up to three hours of a nurse’s day.
UiPath software robots are now responsible for this task. They process the data in a fraction of the time, distributing patient results in minutes and consequently freeing up to 18 hours of each IPC nurse’s time each week, and up to 936 hours over the course of a year. As a result, the healthcare professionals can spend more time caring for their patients and less time on repetitive tasks and admin work.
Is there any possibility of error with software robots, compared to humans?
By nature, humans are prone to make mistakes, especially when working under pressure, under strict deadlines and while handling a large volume of data while performing repetitive tasks.
Once taught the process, software robots, on the other hand, will follow the same steps every time without the risk of the inevitable human error. Simply speaking, robots can perform data-intensive tasks more quickly and accurately than humans can.
Which members of staff benefit the most, and what can they do with the time saved?
In the case of Mater Hospital, the IPC unit has adopted a robot for every nurse approach. This means that every nurse in the department has access to a robot to help reduce the burden of their admin work. Rather than spending time entering test results, they can focus on the work that requires their human ingenuity, empathy and skill – taking care of their patients.
In other sectors, the story is no different. Every job will have some repetitive nature to it. Whether that be a finance department processing thousands of invoices a day or simply having to send one daily email. If a task is repetitive and data-intensive, the chances are that a software robot can help. Just like with the nurses in the IPC, these employees can then focus on handling exceptions and on work that requires decision making or creativity - the work that people enjoy doing.
How can software robots most benefit healthcare providers both during a pandemic and beyond?
When the COVID-19 outbreak hit, software robots were deployed to lessen the administrative strain healthcare professionals were facing and give them more time to care for an increased number of patients. With hospitals around the world at capacity, every moment with a patient counted.
Now, the NHS and other healthcare providers face a huge backlog of routine surgeries and procedures following cancellations during the pandemic. In the UK alone, 5 million people are waiting for treatment and it’s estimated that this could cause 6,400 excess deaths by the end of next year if the problem isn’t rectified.
Many healthcare organisations have now acquired the skills needed to deploy automation, therefore it will be easier for them to build more robots to respond to the backlog going forwards. Software robots that had been processing registrations at COVID test sites, for example, could now be taught how to schedule procedures, process patient details or even manage procurement and recruitment to help streamline the processes associated with the backlog. The possibilities are vast.
The technology, however, should not be considered a short-term, tactical and reactive solution that can be deployed in times of crisis. Automation has the power to solve systematic problems that healthcare providers face year-round. Hospital managers should consider the wider challenge of dealing with endless repetitive work that saps the energy of professionals and turns attention away from patient care and discuss how investing in a long-term automation project could help alleviate these issues.
How widely adopted is this technology in healthcare at the moment?
Automation was being used in healthcare around the world before the pandemic, but the COVID-19 outbreak has certainly accelerated the trend.
Automation’s reach is wide. From the NHS Shared Business Service in the UK to the Cleveland Clinic in the US and healthcare organisations in the likes of Norway, India and Canada, we see a huge range of healthcare providers deploying automation technology.
Many healthcare providers, however, are still in the early stages of their journeys or are just discovering automation’s potential because of the pandemic. I expect to see the deployment of software robots in healthcare grow over the coming years as its benefits continue to be realised globally.
How do you see this technology evolving in the future?
If one thing is certain, it’s that the technology will continue to evolve and grow over time – and I believe there will come a point in time when all processes that can be automated, will be automated. This is known as the fully automated enterprise.
By joining all automation projects into one enterprise-wide effort, the healthcare industry can tap into the full benefits of the technology. This will involve software robots becoming increasingly intelligent in order to reach and improve more processes. Integrating the capabilities of Artificial Intelligence and Machine Learning into automation, for example, will allow providers to reach non-rule-based processes too.
We are already seeing steps towards this being taken by NHS Shared Business Service, for example. The organisation, which provides non-clinical services to around two-thirds of all NHS provider trusts and every clinical commissioning organisation in the UK, is working to create an entire eco-system of robots. It believes that no automation should be looked at in isolation, but rather the technology should stretch across departments and functions. As such, inefficiencies in the care pathway can be significantly reduced, saving healthcare providers a substantial amount of time and money.