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Do We Really Need to Build New EHRs?

I recently attended an American Academy of Medical Colleges conference in Washington DC that presented a futuristic vision of technologies that could provide healthcare encounters using Alexa-like virtual assistants. These solutions would be used to facilitate higher quality healthcare delivery between the provider and the patient.

Our panel discussed a paper[1] that was written to provide a scenario of how that technology would work. This well-written, well-thought-out paper from experienced healthcare professionals includes action items for assessing future implementations.

During the discussion, one panelist who represents a large payer company talked about the need to completely rebuild the EHR environment. The panelist said that the EHRs of today are poorly designed for supporting healthcare, and the industry needs to build new EHRs to support emerging healthcare-delivery models.

In many cases, EHRs are not well-designed relative to graphical user interfaces (GUIs) or the flexible workflows needed to support provider care delivery. In some cases, the architecture of EHRs is outdated; if the architecture isn’t updated, it will relegate the EHR vendors to failure. Still, several EHRs have very good architecture that positions them well for supporting future EHR extensions for population health and intuitive patient interactions.

As the provider industry continues to consolidate, many smaller EHR vendors without competitive EHRs will become obsolete as large enterprise provider networks push their acquired and/or managed providers to use a common EHR. The EHR replacement decisions will be made by providers moving forward.

EHRs capture and store great amounts of information that will be needed to support machine learning and the delivery of virtual assistants (like Alexa). Redesigning the EHRs is economically feasible if we approach the redesign by using web applications supported by mobile devices to provide new GUIs and workflow solutions. This methodology is supported by SMART[2] and FHIR[3] approaches for improving interoperability between EHR environments.

A total rebuild for most EHRs is not economically feasible for enterprise provider environments. History has demonstrated time and time again that when an EHR vendor pursues a rebuild of their environments, they create significant business risks for themselves.

After all, when the vendor tells the market they are building a new EHR, their current EHR customers immediately understand that their current EHR investment has an expiration date that will require them to update to the new EHR or seek an EHR from another vendor. In many cases, the vendor releasing the new EHR will lose customers and important market share.

Before providers seek a new EHR, they need to first determine whether they are using their current EHR to its optimum capability. Arch Collaborative research continues to demonstrate that provider organizations who adequately train and continually educate their providers on how to become proficient with the EHR (including higher levels of personalization-tool use) and who provide appropriate EHR support staff can drive high EHR satisfaction within their organizations.

One organization we surveyed requires its physicians to agree to become proficient with the EHR as part of their admitting privilege process. Making the providers accountable for EHR proficiency is an approach all organizations should embrace when they provide the required levels of training, education, and EHR support.

Consider the difference between these two organizations:

EHR Chart

 

Rewriting current EHR solutions is a multi-billion-dollar investment with a significant chance of failure. If we took even a fraction of that money and put it into helping every organization deploy their current EHR at the highest possible level, would we be better off?




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[1] Care-Centered Clinical Documentation in the Digital Environment: Solutions to Alleviate Burnout; A. Ommaya, P. Cipriano, D. Hoyt, K. Horvath, P. Tang, H. Paz, M. Francesco, S. Hingle, S. Butler, C. Sinsky; National Academy of Medicine, January 29, 2018

[2] https://smarthealthit.org/an-app-platform-for-healthcare/about/

[3] https://www.hl7.org/fhir/overview.html
Photo Cred; Shutterstock, marekuliasz