Adoption of electronic health records since 2009 has been rapid and pervasive in the healthcare industry. Using meaningful use as a barometer, 95 percent of all eligible hospitals and 54 percent of office-based physicians have installed the systems to an extent enough to qualify for incentive funding under the federal EHR Incentive Program.
But there’s mixed opinion on whether those systems have delivered real value. Much depends on the measuring stick that researchers hold against EHRs.
For example, the ability to derive value from the systems has been limited by ease of use issues, contends the American Medical Association. The national professional association for physicians is becoming more vocal in its message that the very incentives intended to drive widespread adoption of EHRs have exacerbated and, in some instances, directly caused usability issues.
Meanwhile, a survey of healthcare organizations with a track record of EHR investment and expertise report that their executives are convinced that they are getting a return on their electronic investment. Still, those same executives report lack of satisfaction with the systems among nurses and physicians, which limits the value the EHRs could deliver to their organizations.
Answering the question of value will become even more crucial, as healthcare organizations continue to invest time, effort and money in installing and optimizing their use of clinical systems. Achieving value, in terms of return on investment, will be essential in coping with value-based care models.
The survey of hospitals with “highly sophisticated EHR systems” by the Healthcare Information and Management Systems Society (HIMSS) found that the benefits of using EHRs for these institutions far outweigh any of the perceived pitfalls, researchers concluded.
The 2016 HIMSS Value of Health IT Survey found that 88 percent of healthcare organizations with advanced EHR environments identified at least one positive outcome from their use of an EHR. Some 83 percent reported increased efficiencies in their respective clinical staff’s quality performance. In addition, 81 percent indicated that their organization documented at least one positive impact in achieving savings.
Still, challenges exist. Only 44 percent of respondents from these organizations reported that the EHR systems increased nurses’ satisfaction, and only 29 percent reported increased satisfaction among physicians. Researchers attributed the staff satisfaction results to the “significant disruptiveness the EHR has for clinicians.”
Because the 52 executives surveyed by HIMSS represent an elite group of healthcare organizations—all HIMSS Analytics EMRAM Stage 6, Stage 7 and Davies Award winning hospitals—the results are not surprising, according to Sarah Corley, chief medical officer of vendor NextGen Healthcare and vice chair of the Electronic Health Records Association.
“One would expect these findings, since all respondents are high-performing organizations,” Corley says. “We find the survey is a valid reflection of the experiences of this subset of users. However, this is not going to reflect the broad experience of the market, because most organizations are not at this level of sophistication. It does, however, show that with focus and attention to optimizing health IT deployment, organizations should expect to see value, as experienced by this cohort.”
But the experience of the few high-performing organizations in the HIMSS survey does not reflect the fact that most providers are struggling to achieve value from expensive IT investments, critics argue. The AMA has raised its posture nationally to express members’ needs for more usable systems that provide value in their clinical practices.
“Most electronic health record systems fail to support efficient and effective clinical work," argues AMA President Steven J. Stack, MD. “This has resulted in physicians feeling increasingly demoralized by technology that interferes with their ability to provide first-rate medical care to their patients.”
At the same time, while the use of EHRs in healthcare is near ubiquitous, the industry still suffers from a lack of interoperability between these systems. For instance, only about 40 percent of hospitals nationwide routinely have electronic access to necessary clinical information from outside providers or sources when treating a patient, according to the Office of the National Coordinator for Health IT.
And, although EHRs have the potential to reduce medical errors and adverse events, providers have seen a range of unintended consequences that actually introduce new areas of risk, including the misidentification of patient records.
“Patients receive care in many different healthcare environments, and these environments are often unconnected,” says Tejal Gandhi, MD, president and CEO of the National Patient Safety Foundation. “Our system is currently too fragmented to ensure that all of the information gathered in each setting gets reported, recorded, and addressed where it should.”
Still, HIMSS researchers and the advanced EHR organizations that participated in the recent survey say their experiences should encourage others in the industry to persevere and anticipate achieving eventual value for their efforts.
Lorren Pettit, vice president of research for HIMSS, calls these providers the EHR “pioneers” who are “seeing what the land ahead looks like for others and are reporting back.” These leading organizations are documenting the benefits of EHRs in clinical settings, he believes, and there is much that can be learned from them.
Case in point: HealthNet, Indiana’s largest federally qualified health center, which was named a 2015 HIMSS Ambulatory Davies Award recipient. With the assistance of an EHR and a variety of IT interventions, HealthNet has reduced low birthweights, improved care outcomes for pediatric patients, and significantly increased patient satisfaction. In addition, the use of the EHR system from eClinicalWorks improved patient management and billing, which has produced a 230 percent return on investment since 2009.
“We never had the ability before to track these kinds of data elements,” contends Donald Trainor, MD, chief medical officer at HealthNet, who has led the organization through its EHR implementation across approximately 40 locations. “We can actually run reports that look at our entire universe of 60,000 active patients and measure quality outcomes.”
QuoteMost electronic health record systems fail to support efficient and effective clinical work.
HealthNet’s experience speaks directly to the value discussion, says Eric Helsher, vice president of client success for Epic, one of the country’s largest EHR vendors. Optimized use of such systems enable health systems to continuously pick specific clinical improvement or cost-reduction goals and achieve them. “Health systems we work with have reduced infections, averted diabetes-related amputations, increased depression screening, and provided better and less expensive care by remotely monitoring patients in the hospital or at home,” Helsher says.
Centura Health, which manages 16 hospitals in Colorado and Kansas, has derived value from its implementation by achieving a significant reduction in medication errors through using its hospital and ambulatory EHR system from MEDITECH. In addition, the 2015 HIMSS Enterprise Davies Award winner used its systems to reduce hospital readmissions for patients with chronic conditions.
"Spread out as we are with 16 hospitals, trying to do this without EHR technology would be impossible,” says Dana Moore, senior vice president of information technology at Centura. “What having a good EHR does is it provides a foundation to build upon to find those problem areas and to start solving them.”
However, Pettit acknowledges there is a “learning curve” for realizing these kinds of clinical efficiencies. “It’s not a slam dunk. You don’t just slap in the EHR and then tomorrow you see benefits,” he concludes.
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