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.
Getting ready for cloud data-driven healthcare
As healthcare continues to recognise the value of data and digital transformation, many organisations are relying on the cloud to make their future-forward and data-centric thinking a reality. In fact, the global healthcare cloud computing market was valued at approximately $18 billion and is expected to generate around $61 billion USD by 2025.
At the forefront of these changes is the rapid adoption of cloud-based, or software-as-a-service (SaaS), applications. These apps can be used to handle patient interactions, track prescriptions, care, billing and more, and the insights derived from this important data can vastly improve operations, procurement and courses of treatment. However, before healthcare organisations can begin to dream about a true data-driven future, they have to deal with a data-driven dilemma: compliance.
Meeting regulation requirements
It’s no secret that healthcare is a highly regulated industry when it comes to data and privacy – and rightfully so. Patient records contain extremely sensitive data that, if changed or erased, could cost someone their life. This is why healthcare systems rely on legacy technologies, like Cerner and Epic EHRs, to manage patient information – the industry knows the vendors put an emphasis on making them as secure as possible.
Yet when SaaS applications are introduced and data starts being moved into them, compliance gets complicated. For example, every time a new application is introduced into an organisation, that organisation must have the vendor complete a BAA (Business Associate Agreement). This agreement essentially puts the responsibility for the safety of patients’ information — maintaining appropriate safeguards and complying with regulations — on the vendor.
However, even with these agreements in place, healthcare systems still are at risk of failing to meet compliance requirements. To comply with HIPAA, U.S. Food and Drug Administration 21 CFR Part 11 and other regulations that stipulate the need to exercise best practices to keep electronic patient data safe, healthcare organisations must maintain comprehensive audit trails – something that gets increasingly difficult when data sits in an application that resides in the vendor’s infrastructure.
Additionally, data often does not stay in the applications – instead healthcare users download, save and copy it into other business intelligence tools, creating data sprawl across the organisation and exposing patient privacy to greater risk.
With so many of these tools that are meant to spur growth and more effective care creating compliance challenges, it begs the question: how can healthcare organisations take advantage of the data they have without risking non-compliance?
Yes, healthcare organisations can adhere to regulations while also getting valuable insights from the wealth of data they have available. However, to help do this, organisations must own their data. This means data must be backed up and stored in an environment that they have control over, rather than in the SaaS vendors’ applications.
Backing up historical SaaS application data directly from an app into an organisation’s own secure cloud infrastructure, such as AWS or Microsoft Azure, makes it easier, and less costly, to maintain a digital chain of custody – or a trail of the different touchpoints of data. This not only increases the visibility and auditability of that data, but organisations can then set appropriate controls around who can access the data.
Likewise, having data from these apps located in one central, easily accessible location can decrease the number of copies floating around an organisation, reducing the surface area of exposure while also making it easier for organisations to securely pull data into business intelligence tools.
When healthcare providers have unfettered access to all their historical data, the possibilities for growth and insights are endless. For example, having ownership and ready access to authorised data can help organisations further implement and support outcome-based care. Insights enabled by this data will help inform diagnoses, prescriptions, treatment plans and more, which benefits not only the patient, but the healthcare ecosystem as a whole.
To keep optimising and improving care, healthcare systems must take advantage of new tools like SaaS applications. By backing up and owning their historical SaaS application data, they can do so while minimising the risk to patient privacy or compliance requirements. Having this ownership and access can propel healthcare organisations to be more data-driven – creating better outcomes for everyone.