Question

Discuss the challenges, opportunities and future of EHRs and EMRs in the American Health care system.

Answer 1

The Hurdles Facing EMR
If EMR is almost universally used, it must be amazing software, right? Well, unfortunately that’s not always the case. In a 2018 survey of physicians by Deloitte, only 10 percent said they would leave their current EHR system as it is. The rest wanted at least one thing changed or updated — often more than one thing. So far as EMR software trends are concerned, different studies have resulted in different findings, but one thing is fairly consistent: physicians hate EMRs.

And they have good reason to. According to Kimberly Reich, Privacy and Compliance Officer for Lake County Physicians, “Cost continues to be the most significant and major barrier that affects healthcare practitioners from adopting EMR.” While large hospitals can foot the bill for a system that costs thousands (or hundreds of thousands) of dollars, the price point of many EMRs continues to be prohibitive, especially for small practices.

And the cost of EMR doesn’t only lie with the software itself. The human cost of EMR is exorbitant. Jeff Riggins, health IT expert and digital media consultant at Drury University, sums up the issues with current EMR nicely:

“Sadly, most EMR software is terribly inadequate. They were built on obsolete platforms with little thought dedicated to user experience. Most EMR packages started as billing systems slowly adding clinical components to gain market share. The design phase was largely overlooked as the functionality of the system was all the government had created guidelines for. This is why physicians complain they have to click 30 times to give a patient a sleeping pill.”

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The combination of excessive documentation expectations and poor UX result in physicians being overburdened and burned out. Burned out physicians, nurses and other staff seek ways to legitimately reduce their data entry workload, resulting in mistakes or cutting corners. According to Douglas W. Bowerman, MD:

“The medical record has become unreliable due to inappropriate use of features like copy-paste. With many doctors, you don’t bother reading their note because you don’t know if you can trust it. This creates inefficiency because you have to go to the source to verify it. It’s a big safety and efficiency issue. This means that patient records are not always correct, reducing the value of the EMR system overall and contributing to errors in patient care. The future of health EMR needs to change, and judging by some of the issues currently facing it, it needs to change in big ways.”

The Future of EMR
So EMRs have come a long way, but they still have a long way to go. What does electronic medical records’ future hold? Soon, EMR will be focused on the model of value-based care as the industry switches over from volume-based models. Humans are going to continue to get sick and need care (at least until we all upload our consciousnesses into robots — but that’s an article for 3019), so we’re going to need to be taken care of. Here are some electronic medical records trends to keep an eye out for in the coming years.

Accessibility
Bowerman predicts we will see “A continued trend towards accessibility” in EMR, both in terms of how the software is accessed — on mobile, for instance — and who can access the software.

The main thing holding practices back from adopting EMR has to do with accessibility. EMRs are incredibly expensive — up into six or even seven figures for total cost. While hospitals and large multi-facility networks are given government incentives to implement EMRs, the same is not true of smaller practices. According to Amy Leopard, partner and Health IT specialist at Bradley, “Post-acute and home healthcare providers have not had the same financial incentives that hospitals and physicians enjoyed, so their take up rates have been lower.”

Reich agrees. She argues,“a lot of people lack time along with the lack of knowledge and training in health IT,” which makes utilizing an EMR correctly a challenge. And there is a big difference between using one right and just using one. EMR vendors will need to make their products more accessible to a wider range of practice types if they want the illusion of the hated EMR to go away.

Integration and Interoperability
Another serious issue with EMRs is their lack of ability to integrate with other EMR systems. When a patient is admitted to a hospital, for example, that hospital needs records from outpatient practices and any other hospitals this patient has visited previously in order to get a full picture of their health. This seems like it would be a top priority for EMR developers, but that isn’t actually the case. Physicians and hospital staff must manually enter data, upload unsearchable scans of information or figure out a workaround to enter crucial patient data into the system.

Riggins says:

“Dissatisfaction with EMR software is driving burn out across all care settings. The lack of interoperability caused by an absence of data sharing standards, along with organizations engaging in data blocking, have created problems for patients who seek care from multiple organizations. This stress is shared by the clinicians who care for them. Without a set of robust standards for data storage, access and sharing, interoperability will continue to be the elusive unicorn of the EMR world. I hope we will see a massive public/private partnership focused on reducing the regulatory burden now placed squarely on clinicians and instead create an environment for progress toward true interoperability.”

This issue doesn’t just hinder the transfer of trivial information — it can literally be a life-and-death issue. Luckily, Leopard foresees this changing sooner rather than later. She explains:

“This is the year where interoperability is getting a lot of attention from the government, providers and vendors. Hopefully the needle will move, particularly where interoperability can help gather data for the physician that is useful at the point of care.”

If EMR vendors are paying any attention, interoperability and integration features will be at the top of their list for upgrades and changes in 2020 and beyond.

Searchability and Ease of Use
It’s not just the ability to use an EMR with other EMRs that’s causing trouble — using even one EMR is widely known to be something of a hassle. Bowerman mentions with some incredulity, “I have no explanation for the discrepancy between the quality I know we’re capable of producing and the quality of what we have at the present. There needs to me more ease of use in terms of navigating through data.” Despite how advanced general technology has become, EMR seems to be lagging behind in user-friendliness and ease of use.

Leopard agrees:

“The biggest challenge at the moment is to address the physician workflow and usability pain points. There is a vast recognition that physicians are overburdened with the documentation requirements. EHR and healthcare technology generally need to be better optimized so they can avoid routine clerical functions and interact with patients more fully.”

If an electronic health record can’t be more easily searched, used and organized than paper files were, what’s the point? EMR needs to keep its users in mind and take physician feedback seriously in the future if it wants to shake the reputation of being cumbersome and disorganized.

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Standardization
One way that ease of use can be legitimately achieved in the near future is through standardization. The current standards that regulate EMR are very lax — for instance, according to Kimberly Reich, one vendor had to pay $155 million in settlements because it was giving customers kickbacks for falsely claiming it met meaningful use certification requirements .

If vendors are going to be held accountable for providing the features users actually need and upholding meaningful use standards, there have to be more regulations. Reich explains that in order to make this happen, “data standards should be consensus-based, transparent, well-documented and openly available in a nondiscriminatory way.”

And it’s not just data and features that need standardization. Bowerman wants to see separate interfaces for physicians and medical billing coders. What the physician needs to see and know about the patient’s medical history is very different from what the biller needs to see. When both user groups see the exact same screens when looking at patient info, it can cause miscommunications and confusion that can be life-threatening. Standardizing differences in how conditions are entered for billing vs for treatment — or separating those views altogether — will go a long way in making the systems easier to use as well.

Changing Dynamics
Technology is progressing at a breakneck pace, and this will definitely have some impact on the EMR of the further future. As AI and virtual assistants like Alexa and Siri become more accessible and more powerful, they will begin to appear in the health IT fields. Leopard thinks this will happen soon, and in a big way:

“Virtual assistants are also coming online to help with those physician burdens, in particular the aspects of the physician workflow issues that computers can streamline. For patients, the big development is expanding online or smartphone access to your health information and the ability to combine information from different providers and update it automatically.”

By shifting some of the data-entry work off of the overburdened shoulders of physicians and other practice staff, some of the main issues with EMR can be mitigated without huge system changes.

But other experts think EMR vendors will have to look beyond a patch for the problem. Riggins says tech giants entering the healthcare space are going to make big waves:

“Apple, Google and Amazon are all entering the healthcare space. Their presence will pressure EMR vendors to innovate or perish. The large tech giants have the funds to invest in R&D and leading edge UX and UI without endangering their bottom lines. They have witnessed the problems created by the lack of interoperability between systems and will not make those mistakes. It will be exciting for consumers and clinicians and not so exciting for current EMR companies.”

This competition might force EMR to make some of the crucial changes that previous sections have mentioned, or it might just increase the monopoly these tech giants have begun to form and change healthcare for the worse. There’s no surefire way to know how it will play out, but big changes are definitely coming.