Providers look to ramp up efforts to optimize records systems
The federal government’s Meaningful Use Program—intended to incentivize healthcare organizations to rapidly adopt electronic health records systems—provided significant impetus to get providers to invest in digital records systems.
In 2009, when the MU program began, as one of the key objectives of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and the Federal Health IT Strategic Plan, fewer than one of eight (12.2 percent) non-federal acute care hospitals had record systems in place, according to data from the American Hospital Association. By 2015, seven out of every eight hospitals had a basic EHR in use (83.8 percent), and that percentage has inched even higher, four years later.
Now, after billions of dollars in investment in EHR technology over the past decade, healthcare organizations are trying to cash in. Meaningful use is transitioning into measurable results.
Key initiatives in achieving EHR optimization include both better ability to use the data in the system to achieve improvements in care delivery and outcomes, as well as increased usability and ease of use to make it easier for clinicians both to use the systems, and more quickly find the information and guidance they need at the time it’s most crucial.
Recent research suggests that healthcare organizations are a long way from truly optimizing their use of digital records systems, and results of a survey by Health Data Management also underscores the importance that healthcare IT professionals now ascribe to EHR optimization.
The survey found a wide separation between how HIT executives view the effectiveness of their use of EHRs vs. the importance of achieving such optimization.
In fact, a total of nearly three out of four respondents (72 percent) said achieving EHR optimization is either extremely important or very important for their organizations. By contrast, only 35 percent of respondents said their organizations were either extremely effective (12 percent) or very effective in optimizing use of their EHR systems.
The study was conducted by Health Data Management and SourceMedia Research, the research arm of HDM’s parent company. A total of 160 responses, primarily from provider organizations, were received in late 2018.
Healthcare organizations are beginning to see mounting evidence that optimization of EHR systems can pay dividends in improving patient care and facility operations.
For example, hospitals with the highest use of electronic health records discharge their patients quicker, according to a study from Case Western Reserve University. According to researchers, hospitals that meet federal standards for Meaningful Use of EHRs discharge patients about four hours earlier, which equates to a 3 percent reduction in the average five-day hospital stay. Further, patients with complex conditions have an additional 0.5 percent reduction in their stay, while the overall reduction in stays does not result in increased re-admissions.
As a result, use of EHRs can better contain growing healthcare costs in an era of reduced reimbursement for treatment, says Manoj Malhotra, dean of the Weatherhead School of Management at Case Western and co-author of the study. “Electronic health records when meaningfully implemented help patients go home sooner, reducing their exposure to germs in the hospital and likelihood of coming back,” Malhotra adds.
Optimization also result in benefits for clinical staff. For example, Carolinas Healthcare System worked on optimizing clinical documentation among the nursing staff and over three years, it was able to remove 18 million clicks out of the documentation workflow, says Becky Fox, chief nursing informatics officer. “We have had an electronic health record system for 10 years, so while we were focused on the meaningful use program, we have not leveraged the EHR technology to make sure we were using all of its functionality to its highest level,” Fox adds.
Optimizations of EHRs also can help ameliorate risks of EHR shortcomings. The need here is pressing—a viewpoint article in the February 2019 issue of the Journal of the American Medical Association indicates that usability challenges in the last decade have had unintended consequences. Poor EHR usability contributes to errors that are associated with patient harm. It also results in clinicians spending extra time using the EHR, contributing to clinician frustration, which, in turn, has been reported to jeopardize patient safety.
“Clinician and patient expectations for better usability are high,” the viewpoint article continues. “Usability of commonly used software tools has improved exponentially in the past decade (smartphones, office computing software, productivity utilities), in contrast to HIT usability. The next step for improving usability is a shared responsibility that requires collaboration and action by HIT vendors; policy makers, including federal regulators; clinicians; healthcare organizations; patients; and researchers.”
Despite the growing urgency to improve the use of EHR in care delivery, the current use of the technology remains fairly simple. Respondents to the HDM survey indicated that their organizations use EHRs to record clinical documentation (74 percent of respondents), manage medication lists (67 percent) and for care reporting purposes (63 percent).
Slightly more than half of respondents said their organizations use EHRs for care plan management (56 percent), document management (56 percent), electronic lab management (55 percent), e-prescribing (54 percent) and for generation of patient instruction documents (54 percent).
More complex uses of records systems are not as widely used. For example, 47 percent of respondents say their organizations use their EHRs for clinical decision support, and 49 percent use it as a basis for clinical messaging.