EHR interoperability, regulations top patient record concerns
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As healthcare providers follow the latest regulations in the recently released meaningful use stage 3 final rule, one thing is clear: Organizations are entering the post-meaningful use era and are set to embark on a flush of IT spending to optimize electronic health records (EHRs). Look for EHR investments to integrate with cutting-edge technology that captures, sorts, organizes and analyzes patient data to create efficiency and improve patient care.
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According to CMS, more than 70% of eligible physicians and other clinicians and more than 95% of eligible hospitals have successfully used EHRs and received incentive payments. Now that the goal of widespread EHR adoption has been achieved, the next push to advance the benefits of EHRs will be to prepare the technology for greater interoperability and data sharing with digital records.
CMS is along for that ride, as stage 3 requires providers to connect their EHRs to exchange information with public health organizations, as well as link EHRs to patients so they can access electronic copies of their health information.
Another provision finalizes the use of APIs that advance new functionalities, connect disparate systems and increase data access. Through APIs, health IT executives will work toward obtaining goals such as helping patients access data via mobile devices.
While hospitals are being asked to meet these and other requirements, many health organizations are also looking to invest in systems that unleash the potential of EHRs. Until now, EHRs have been used as data-entry platforms to comply with government regulations, said Judy Hanover, research director at IDC Health Insights in Framingham, Mass.
"As we look three to five years out, what we are seeing is a digital transformation," Hanover said.
She noted that health providers want to add new technology to benefit EHRs as they organize patient data to drive their business models. The technologies providers will use to optimize their EHR systems include:
- Cloud computing platforms;
- Cognitive computing;
- High-sensitivity and high-specificity decision support software;
- Data analytics and predictive modeling software;
- Customer relationship management software; and
- Mobile technology.
Describing the return on EHR investments as "soft and difficult to measure," Hanover said future health IT spending will be pushed by the need to realize the full value of previous electronic records spending, and that effort will restructure how EHRs and supporting systems are acquired.
"There'll be enhancements and replacement to the core systems that have been implemented because of meaningful use requirements," Hanover said. "We are going to see more and more department- and role-specific technology that operates on the same platform. There'll be a lot of innovation once you get past the regulatory requirements."
Benefits of EHRs branch out
One organization moving in this direction is Dallas-based Children's Health System of Texas, which operates a pediatric trauma center, 18 primary care facilities and 23 community practices. Part of the organization's IT strategy is upgrading systems with new medical devices because older equipment doesn't transmit patient information well to EHRs, said Pamela Arora, CIO at Children's Health.
Pamela AroraCIO, Children's Health System of Texas
"We want to have snapshots of our pediatric patients' health information fed into the electronic health record," Arora said. "Increasingly, you are going to see all these medical devices feeding into the EHR, and that's yet another investment because some of the older medical devices don't always have that capability."
Arora also said that her hospital system has begun the process of shifting its resources from EHRs to other technology. The hospital spent $65 million in 2007 to install EHRs; it uses Epic Systems Corp.'s system for its critical care operations and Cerner Corp.'s EHR for its blood bank and lab data.
Looking ahead over the next five years, Arora said the system will spend $75 million to $80 million on health IT. Funding will go toward maintaining EHRs, improving home health practices by integrating more patient data from remote locations via mobile devices, and extending the use of EHRs to health information exchanges, community hospitals and physician practices.
Additionally, Children's Health will enhance interoperability among different healthcare systems at the local, state and federal levels. The organization is also forging ahead with population health analytics and plans to migrate its financial data to a cloud computing environment.
"Leveraging your EHR is a constant investment -- but not on what you've already invested in," Arora said. "It's investment on implementing new capabilities and expanding the reach of the EHR that makes the difference."
Quality care stems from EHR investments
John Bosco, CIO at North Shore-LIJ Health System, also confirmed that his organization will spend less on EHRs, which now require only upgrades and upkeep. However, that doesn't mean overall IT spending is shrinking.
Headquartered in Great Neck, N.Y., North Shore-LIJ operates 21 hospitals, and more than 400 outpatient physician practices and other ambulatory facilities. After spending close to $500 million for its EHR systems, North Shore-LIJ intends to improve the use of its EHR from Allscripts Healthcare Solutions Inc. through initiatives that connect it with mobile devices and wearable technology; it also plans to apply analytics and predictive software to EHR data.
Bosco estimates that North Shore-LIJ's IT expenses overall will continue to grow somewhere in the neighborhood of 5% to 10% annually over the next five years. "We are looking at what we can do to get the most value out of our EHRs, as we march down the path of data warehouse and analytics capabilities," he said.
In a move that links patients' claims information with analytics software, North Shore-LIJ recently partnered with Optum Inc., a UnitedHealth Group software provider that focuses on population health management. Part of the strategy is to identify high-risk patients who require a greater level of monitoring and care.
According to Bosco, for patients with significant chronic disease conditions, care management organizations can prevent their health from worsening and thus becoming more expensive to treat if they better oversee these high-risk patients. One example Bosco cited is examining the patient records of a woman with a high risk for breast cancer. If her records show that she has not had a mammogram in three years, then the provider can remind her to come in for an exam.
He also said hospitals need to be able to steer patients efficiently through their care. Analytics software combined with the benefits of EHRs enables healthcare providers to identify who the highest risk patients are going to be, and then intervene earlier on their behalf.
"By using EHR data, claims and billing information, and matching that with analytics and other care management technology, healthcare providers can navigate patients through the health system as efficiently and effectively as possible," Bosco said. "That's going to be the difference between efficient and high-quality care, and care that is more expensive without better outcomes for the patient."
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