You wouldn't want your doctors talking to their patients and peers on a dusty old flip phone that can't even check emails. So, why put a dusty old electronic health record in their hands that can barely perform the functions needed to transform their work?
Experts are advocating that hospitals and health systems say goodbye to outdated EHRs, technology that was more geared toward completing a transaction, and move to one that deals in value. Such a smart or intelligence-based EHR could have the ability to identify and correct mistakes in data, alert a doctor if a patient is a threat for readmission, or offer shared work lists in the cloud for the whole care team.
Some of that technology has existed for years, and it's not a question of jumping from an unintelligent EHR to a smart one, says John Glaser, CEO of health services at Siemens Healthcare. Rather, it's more of a "shift of emphasis" for your system — away from just gaining payment and toward accountable, evidenced-based care.
But how do hospital leaders know where to start and whether their EHR needs a makeover or a gut job? Glaser suggests sitting down with current technology vendors and talking about the hospital's goals for the future.
"In some cases, scrapping will be necessary because the vendor doesn't understand or is incapable or just doesn't want to," Glaser says. "In other cases, it will be that they can do part but not all [of your goals], and there becomes the harder question: 'How much does that hinder me? I need to achieve these goals and I want to have the most robust set of tools possible but, on the other hand, replacing these things is expensive and very time-consuming."
Chester County Hospital in West Chester, Pa., is one provider working to shift its electronic health record system toward the intelligence side. Elements of its new approach include a real-time clinical dashboard that can send reminders to doctors at steps along the process, along with prompts to reorder supplies, which also can be viewed by nurse managers and clinical executives.
One of the biggest challenges has been trying to get agreement from physicians on the optimal process, and how to manage certain scenarios.
"There is a lot of disparity in the way medicine is practiced by different physicians, across different conditions, on different floors," Hess says. "You're trying to come up with, using evidenced-based standards, the best approach to accomplishing whatever the goal is."
At the Department of Defense and the Department of Veterans Affairs, leaders are working to implement by 2017 an integrated EHR that will serve more than 18 million members. Features will include a "complete medical record" that follows patients wherever they go, and allows researchers to study trends across the patient population. But this isn't just another IT project, says Barclay Butler, director of the DoD/VA Interagency Program Office. It's a health care transformation project that's facilitated by IT. Thus, hospitals should put clinicians at the head of such transformation efforts.
"Putting the doctors and nurses in the lead, being supported by information technology, is really the right approach," Butler says. "That's how you get total systems buy-in and that's really how you improve that value proposition — better quality of care for every dollar you expend."