Assessing the EHR landscape in 2017
With implementation encouraged by the Electronic Health Records Meaningful Use program, most healthcare providers now have EHRs in place. Providers express concerns about the systems and ways they could be improved. Several chief information officers suggest ways the systems could make a difference in 2017.
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Demands for EHR improvements
The ease of use issue is growing, and providers are starting to push back on ever-growing EHR documentation requirements and various other frustrations, says Donald Levick, MD, chief medical information officer at Lehigh Valley Health Network in Allentown, Pa.

“People can’t keep up with documentation in real-time and wind up completing it during lunch time and in the evenings,” he notes. “The increasing burnout of providers is creating a backlash that EHR vendors will need to address.”
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Systems struggle to keep up with regulations
Regulators and insurers also need to take notice because their mandates for increased detail in notes further exacerbate documentation woes, Levick says. Vendors are aware of provider complaints, but struggle to balance functionality with ease of use. As vendors work to improve their products, more regulations emerge, and that occupies their resources, delaying product improvement, Levick believes.
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Ease of use gains traction
Still, Levick believes that in 2017 some improvements in ease of use will start to emerge as vendors seek to differentiate themselves from competitors.

There’s a lot of work being done on national standards, particularly the Fast Healthcare Interoperability Resources standard, known as FHIR, but right now it is not clear just how widely FHIR is being incorporated into EHR systems. Interoperability through the Sequoia Project, which operates an emerging national e-health exchange network, has the potential to happen quicker while the industry waits for full maturity of FHIR, Levick says.
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Getting help with documentation
At Inova Health System serving northern Virginia and the Washington region, physicians enter much of the information from procedures into the EHR themselves, and they dictate procedure notes. But the delivery system is moving to structured documentation that allied health personnel will complete.

“The EHR can be a real impediment to physician productivity,” says Marshall Ruffin, MD, chief technology officer. That said, collecting data in coded form is important as physicians need to become more productive, and that data can be collected for clinical research. It’s also important to capture data in coded form as machine learning technology evolves, he adds.
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Technology lends a hand
“These new technologies for machine learning will change everything for us, and we’ll need coded data to make it work” Ruffin adds. “Capturing structured information will make us more productive and support data analytics.” Some 20 years ago, data wonks changed baseball by using analytics to evaluate the performance of players, Ruffin recalls. “That same thing is coming to healthcare, and the EHR will be the tool that supports it.”
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Incremental improvements ahead
At JFK Health in Edison, NJ, anchored by JFK Medical Center, vice president and CIO Indranil Ganguly doesn’t see any one radical trend emerging in 2017, but he sees a slow boil building.

Decision support today doesn’t have a huge base of evidence-based rules, so it doesn’t get as widely used as it needs to be, Ganguly believes. Some doctors are pushing back, saying the technology is not yet mature, and some others are pushing back because they just want to keep practicing the way they currently do.
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Growth in telehealth
Use of telehealth increasingly will grow because patients are open to video or Skype consultations, driven by convenience and cost, and providers want to keep patients out of the hospital, Ganguly predicts. Another incentive for more telehealth is the falling cost for devices that support chronic care management. These devices, such as a glucometers, scales and blood pressure monitors, can remotely collect relevant information and are easy to deploy. An EKG, Ganguly notes, can be done today on a smartphone.

Further, Ganguly sees a big change coming in short order—the return of physician house calls. Medical devices are much smaller than previously—you can carry a lot of equipment in your bag and be connected to wireless communication when conducting home visits with patients. “We are seeing the drive to push as much care to the home as possible and technology is a key enabler of that.”
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Remember the election?
The nation has a new president and Ron Kloewer, CIO at Montgomery County Memorial Hospital in Red Oak, Iowa, is a bit apprehensive. Think of the changes in the industry that EHR meaningful use brought, leading up to today’s emphasis on value-based care where payments reflect the quality and cost of care being given, all supported by EHRs.

President-elect Trump pledged in the campaign to repeal and replace the Affordable Care Act. That’s been tempered a bit since the election but no one really yet knows what programs are going to stay.
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More worries
Kloewer isn’t even sure if the new administration will support the use of EHRs and the MIPs and MACRA programs as much as the departing administration has. He’s worried that the nominated Health and Human Services Secretary is a critic of EHRs.

“In my mind, I cannot believe that this industry will go backwards in terms of the EHR,” he says. “I cannot believe we will scrap MIPS and MACRA. There’s too much value in what we’ve accomplished. The core principles of the Triple Aim are established and relevant.”
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Contraction in EHR options
The electronic health records vendor market is shrinking, and the trend will continue in 2017, as some vendors exit while others get acquired, predicts George Hickman, executive vice president and CIO at Albany Medical Center in New York. It’s similar to shrinkage in the enterprise resource planning sector about 15 years ago that eliminated weaker competitors.

During the next three to five years, the remaining vendors will focus on enhancements to better manage care across the continuum and support analytics to enhance ways of delivering the care. Epic and Cerner will continue to dominate, to no one’s surprise.
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Innovation coming
Hickman’s watching initiatives to improve EHR usability, such as Cerner’s alliance with Intermountain Healthcare to develop workflow standardization that reduces clicks and screen flips. He’s also watching early adopters of the FHIR interoperability standard. However, Hickman doesn’t see traction for FHIR building much next year; there are just too many other competing priorities for providers.

Other interoperability initiatives don’t seem to be on the same path toward success, Hickman says. He thought the Direct secure messaging protocol would be prolific by now, but its numbers are not impressive. He’s waiting for EHR vendors to be able to competently produce, publish, transmit and access continuity of care documents. Population health management is another area that may not have the success being envisioned 2017, Hickman says. It’s the right idea, but structural requirements and cost remain big barriers.