International Summit 2022 White Paper
Focusing on EHR Optimization & Lessons Learned Post-Pandemic

The Pre-Summit Survey

To supplement the group discussions, KLAS administered a pre-summit survey to 132 healthcare organizations based in 40 different countries/territories (excluding the US), asking them about their HIT investment priorities coming out of the pandemic. This same survey was administered in 2019 to healthcare organizations outside the US, allowing KLAS to compare which areas have become higher investment priorities for organizations over the last three years as the pandemic has unfolded.

Organizations Worldwide Continue to Prioritize EHR/Digitalization Investments

EHR and digitalization projects (e.g., new EHR projects, optimization projects for the EHR/other systems, other digitalization efforts) are the top-priority areas of investment for healthcare organizations around the globe. Of the respondents who name these areas as a top priority, about half are investing in new EHR decisions or are continuing to implement and roll out their EHR across their organization. One-fourth of respondents are focusing their efforts on system optimization, while the remaining respondents are working on other digitalization projects, including initiatives like document management. These projects were also a top priority for respondents in 2019, indicating that EHR/digitalization continues to be at the forefront of organizations’ priorities worldwide. Interestingly, this area is less of a priority for organizations in the Middle East; many have been working on implementations and optimization projects over the last decade, placing them one step ahead of counterparts in other regions of the world.

Organizations Are Increasing Focus on Cybersecurity, IT/Infrastructure, and Back-Office Systems

Since 2019, respondents have significantly increased their investment focus in three areas: cybersecurity, IT/infrastructure, and back-office systems. Unsurprisingly, the rise in ransomware attacks among healthcare organizations has prompted respondents to prioritize cybersecurity investment—the percent of respondents reporting cybersecurity as a top priority has more than doubled since 2019. The priority level of IT/infrastructure also jumped significantly among respondents. During the height of the pandemic, many respondent organizations focused on more pressing concerns, like establishing remote connections between patients and providers. Now, those organizations feel they have several years’ worth of maintenance to catch up on. Lastly, more respondents are turning their attention to back-office systems, particularly HR and ERP solutions, as a means to deal with the staffing shortages and hiring challenges that resulted from the Great Resignation.

Digital Health Becomes Less of an Investment Priority

The one area that significantly dropped in priority is digital health (e.g., patient engagement, telemedicine, remote patient monitoring). However, this decrease does not mean digital health is no less important to respondent organizations; many invested so much in digital health during the height of the pandemic that they feel they can finally shift their focus to other areas that have received less attention over the last two years.

Summit Discussion Day 1: EHR Optimization Learnings from the Arch Collaborative

During the first day of the 2022 summit, attendees engaged in small-group discussions to brainstorm how to optimize the EHR experience for clinicians, especially since—as mentioned previously—nearly half (46%) of respondents indicated EHR/digitalization is one of their top three investment priorities. To provide further context for the discussions, KLAS shared the following Arch Collaborative findings: (1) regardless of which vendor’s system is used, healthcare organizations can have satisfied end users, and (2) most variation in EHR satisfaction typically relates to the healthcare organization and the end users themselves. Essentially, a successful EHR experience is largely driven by the organization and the end users.

Many Attendees Say Clinical Workflows Must Be Improved to Enhance Clinician EHR Experience 

With the context from the Arch Collaborative in mind, attendees made several suggestions for improving the clinician EHR experience. One of the most frequently mentioned suggestions is improving clinical workflows; other suggestions include strengthening the interoperability between systems, increasing EHR education and support, involving clinicians in EHR improvement opportunities, and making changes via national policies. The suggestions listed below come from various types of attendees, including healthcare organizations, vendors, investors, and third-party service firms.

Discussion Insights

Attendees came away from the discussion with the following best practices to improve clinicians’ EHR experience:

1. Address workflow issues by making observations, adjusting where needed, and continually improving. If data has already been documented in the chart, find a way to use it.
2. Collaborate with clinicians to hear their perspective. A healthcare organization should prioritize clinical needs and then support them with IT initiatives.
3. Continue to ask for support and excellence from vendors and governing bodies. Just because EHR usability success is largely driven by healthcare organizations doesn’t mean the onus should fall solely on those organizations.

Summit Discussion Day 2: Lessons Learned from the Pandemic and How to Foster Innovation & Development Going Forward

Lessons Learned from the Pandemic

On the second day of the summit, attendees gathered once again in small groups to discuss two topics: (1) what lessons the industry has learned from the pandemic and (2) how to create an ecosystem of innovation. For the first topic, attendees were asked to discuss three different questions:

1. How have the HIT industry’s priorities shifted coming out of the pandemic?
2. How well do current healthcare investments align with shifting priorities?
3. Are local governments and regulatory bodies investing to address shifting needs, or are they still putting out fires?

Question 1 insights: How have the HIT industry’s priorities shifted coming out of the pandemic?

• The biggest change is how much organizations have increased their trust in IT and how quickly and easily organizations can adopt technology to meet rapidly shifting demands.
• The HIT industry’s priorities have shifted because of the pandemic. Patient engagement and digital health technology (e.g., telehealth) have become the new normal as organizations have focused on both the patient and clinician experience. Websites and apps with medical condition information have received significantly more traffic as patients have learned to consume health information in different ways.
• Training is not mentioned as an investment priority and often falls by the wayside, despite its importance. In the midst of the Great Resignation, training is more critical to end-user success than ever before. (To view KLAS research about the importance of training, click here.)

Questions 2 and 3 insights: How well do current healthcare investments align with shifting priorities? Are local governments and regulatory bodies investing to address shifting needs, or are they still putting out fires?

• Without increased IT budgets, most healthcare organizations will continue to have too little to invest in HIT, thus preventing them from adapting and progressing in necessary ways (in some countries, a lack of investment caused healthcare authorities to be ill prepared during the initial outbreak of the pandemic).
• Some good investment initiatives have come about, though more are needed. For example, to address the lack of digitalization in healthcare systems, the EU recently provided massive financing via their Recovery and Resilience Facility (RRF). The RRF’s financial aid will be disbursed by country and spent according to how each country sees fit. This initiative will provide some countries, like Greece, with much-needed funds.
• In addition to the RRF, multiple countries have developed initiatives in recent years to spur digitalization. For example, Germany has issued multiple rounds of funding to be invested in various aspects of HIT. Italy is restructuring their healthcare system—this is currently one of the most ambitious healthcare transformation projects occurring at a national level. France and Portugal have also put money toward digital transformation, strategy, and infrastructure. England has radically shifted their governance structure and created integrated care systems (ICSs), which are regional partnerships of organizations that plan and deliver healthcare services. There is also an increased focus on helping organizations furthest behind in their digitalization efforts instead of merely incentivizing all organizations; the latter usually benefits those that are already more digitally advanced.

Roadblocks to Innovation in Healthcare

Creating an Ecosystem of Innovation

After the first discussion, attendees then moved on to the topic of creating an ecosystem of innovation coming out of the pandemic. Attendees were asked to discuss the following questions:

1. What has the pandemic taught us about innovation?
2. What is the right environment to cultivate a productive digital health ecosystem?
3. How do you transition from having a proven idea to implementing that idea to scale? For example, how do you ensure projects make it past the pilot stage?
4. What are the blind spots or knowledge gaps in provider/vendor/investor partnerships?

Question 1 insights: What has the pandemic taught us about innovation?

• The pandemic brought about some positive things; it accelerated innovation around digital health in ways we had never seen before. In addition to teaching organizations that they can work with patients remotely, the pandemic (1) fostered innovation and quick adaptation, (2) encouraged healthcare providers to embrace innovation, and (3) helped organizations realize they can’t stick to the status quo.
• Obviously, there were some negative outcomes that came out of the pandemic. Organizations learned two things: (1) Although the pandemic prompted many ideas and projects to be quickly and easily implemented, in some cases, decisions were made without enough consideration. As a result, organizations realized the regulation/governance of ideas and funding can actually be a good thing. Also, (2) remote work isn’t 100% sustainable; providers sometimes work longer hours and accommodate too much change, leading to burnout.

Question 2 insights: What is the right environment to cultivate a productive digital health ecosystem?

For innovation to thrive, there must be a confluence of four factors: alignment, partnership, innovation, and a strong technical foundation.

Alignment

• An organization’s ecosystem needs to be aligned across all healthcare levels;this involves having the right funding, the right regulatory environment, the right change management environment, and the right people from every level (including informaticists who understand both the clinical practice and IT). A lack of alignment can lead to a lack of success, as in the examples below:
  • Germany was one of the first areas to reimburse digital apps, and the German government approved several apps that doctors could prescribe as treatments. However, doctors weren’t trained and didn’t want to prescribe these apps. A year later, few doctors were prescribing the apps, causing investors to become impatient.
  • One attendee related how they sometimes fail to get the IT/digital team involved in projects early on, leading to rework. The IT/digital team needs to be brought into the conversation up front and be involved in the whole process.
• Alignment should reward results and not punish failures.
  • One attendee shared that their regional government was willing to provide funding for future projects because of the success of current projects. Investments help build trust and make healthcare organizations more willing to explore future projects.
  • Some EU countries are considering changing the tender process to focus on outcomes, which could potentially better align the process with reality.

Partnership

• Establishing a vendor-client partnership with commitment from both sides is critical. Both vendors and healthcare organizations need to have skin in the game to develop successful strategies. Clients really appreciate being involved in the product conception, development, and evolution. Vendors should also understand the difference between the operating procedures for public health entities and private health entities.
• Vendor and provider partners need to be transparent, honest, invested, clear about the problem being solved, and willing to talk about what things don’t work—it is important to learn from failures and use them to lift both parties. People on both sides should feel empowered and focus on building relationships and teams. Establishing direct communication among the parties instead of passing messages from group to group prevents misunderstanding.

Innovation

• Innovation has to be in healthcare organizations’ DNA; they can’t simply develop innovation committees. Organizations should appoint a specific leader (e.g., chief innovation officer) to foster the spirit and culture of innovation.
• Having an innovation center does not inherently make a healthcare organization the ideal partner. Some organizations have innovation centers that are shiny but not real; the projects and development done there are siloed and cause distraction. Innovation centers work best when they are part of a larger development ecosystem. Be wary of organizations that don’t use the technology they develop—organizations that put their innovations into practice with patients will be better innovation partners.
• In most cases, creative partnerships are driven by passionate people. Contracts sometimes get in the way of innovation. Either they are very restrictive, or too many people want to contribute, making it harder to actually innovate. Innovation team members should rotate (e.g., every six months, though leadership may need to stay in place longer) to allow a broader group of individuals to participate, provide fresh ideas, and learn from each other in a highly collaborative environment.

Strong Technical Foundation

• For innovation to thrive, healthcare organizations must build up a strong technical foundation. This foundation requires a certain level of systems to be in place. For example, during the pandemic, hospitals that already had a patient portal in place were able to monitor nonemergency patients at home rather than have them take up space in the facilities, whereas hospitals that didn’t have a patient portal had to scramble to develop a foundation for a good virtual care platform. Infrastructure (e.g., a hosted or cloud model) is key to developing a good foundation for a successful innovation environment.

Regional collaborations between healthcare organizations can also help foster innovation for organizations that don’t have the resources to innovate themselves. Innovation can be driven by a larger hospital, which can then roll out technology to other rural facilities. (This is happening in France with groupements hospitaliers de territoires [GHTs] and more recently in England with ICSs.) Additionally, vendors can bring findings from more innovative companies to guide healthcare organizations who don’t have the right change management culture. These organizations shouldn’t be left to languish after purchasing a solution.

Question 3 insights: How do you transition from having a proven idea to implementing that idea to scale? For example, how do you ensure projects make it past the pilot stage?

Question 4 insights: What are the blind spots or knowledge gaps in provider/vendor/investor partnerships?

It is often believed that innovation is driven collaboratively by healthcare organizations and vendors. However, investors shouldn’t be overlooked—they can be valuable contributors to innovation. All three parties should seek to learn from each other and avoid assuming they know best. Below are additional recommendations for the three parties as they work to improve their blind spots and knowledge gaps while continuing to innovate.

Healthcare Organizations:

• Have a dedicated role for innovation, like a chief transformation or innovation officer. The person in this role can help move projects forward and help develop a culture of innovation.
• Have realistic expectations and timelines. For example, an organization can’t expect immediate results if they have a long list of RFP requirements.
• Avoid overspecifying and setting unattainable expectations in the RFP or contract. Trying to address every conceivable issue in a contract can hinder innovation, deployment, and the organization’s best interests.
• Clearly communicate to vendors up front what the organization wants; this helps with scoping.

Vendors

• Vendors sometimes offer solutions that don’t address actual problems. Avoid assuming what prospective clients need, work to understand those clients’ needs, and help solve their challenges.
• Don’t say yes just to get business; it is important for vendors to be transparent when they don’t do something, when something isn’t on their road map, or when a solution may not be right for the client.
• Vendor-provider relationships can’t be transactional—they should be strategic partnerships. Healhcare organizations and vendors should also ensure they are the right fit for each other.
• Having a local contact is imperative. Knowledge gaps often come from a lack of planning and collaboration. Have people on the ground who listen to and feel the pain of end users; otherwise, the project won’t move in the right direction.
• Clinical trials should not be overlooked. Regulatory requirements and accreditation are other common blind spots for vendors.
• Investments/acquisitions can work very well when the acquired company/solution is a good strategic fit for and adds value to the acquiring vendor’s portfolio (as opposed to just being another source of revenue for the company).
• Where applicable, vendors need to consider the patient perspective and not solely the clinical/IT perspective.

Investors

• Understand a company’s market before investing. When problems arise, it is important for all partners to understand the business to sufficiently address challenges.
• Know that the procurement/regulation process is long and that it may take several years to see the fruits of your labor.
• Help vendors move beyond innovation funding to structured, budgeted funding. Innovation grinds to a halt when funding runs out, which often happens to vendors after their initial round of funding.

Summit Attendees