With most healthcare organizations having survived implementation of electronic health records, the next steps will center on better design and increased data flow to and from an EHR.
Even looking at statistics from a few years back, the EHR success story is clear. As of 2015, 96% of acute-care hospitals and 78% of office-based physicians had adopted certified EHR technology, according to the U.S. Office of the National Coordinator for Health IT. In short, the market is saturated after the heyday of meaningful use incentive programs, which boosted the implementation of electronic health records.
While there is room to look at new technology investments and better ways to use the horde of patient data held in EHRs, it's unlikely many larger healthcare organizations will opt to rip and replace systems that cost millions -- and in some cases, more than $1 billion -- to install.
"People have spent an enormous amount of money," said Jay Anders, M.D., chief medical officer at Medicomp Systems, which develops a data engine that expands documentation functionality and streamlines workflows for EHRs. "Even after they've been subsidized by Uncle Sam through meaningful use, they still had to invest [to install] these systems."
Physician groups may be more receptive
However, physician practices, by virtue of being smaller than hospital chains, may be more open to overhauls in their health information management technology, said Michael Nissenbaum, CEO and president at Aprima. The company sells EHR and revenue cycle management software to medical practices.
In particular, practices ending their contract after an acquisition from a hospital chain may be longing for new technology investment; such physicians could view this situation as a chance to dictate their own workloads and care plans, Nissenbaum said.
In such cases, EHR technology that offers better integration to behavioral health, physical therapy and pain management specialties could appeal to physician practices that want the freedom to recommend any specialist to a patient, he said.
Integrating EHRs further with clinical support tools and telehealth technology is an important goal, said Natalie Pageler, M.D., chief medical information officer at Stanford Children's Health and clinical associate professor of pediatric critical care and biomedical informatics research at Stanford University.
By expanding the clinical tools available to use EHR data, including advanced analytics software, clinicians can "get that data in near real time, and not only get the data, but get that turned into meaningful information," Pageler said.
New look, beefed up data
Nissenbaum has also seen a growing desire from desktop EHR users to have the same slick interfaces that mobile apps offer. That craving from customers forced Aprima to refresh its desktop design, which he described as "iOS-esque" in its new look and feel. Underneath the new interface, however, the product basically acts the same, he said.
Jay Anders, M.D.chief medical officer, Medicomp
Anders said generally, design consternation felt by clinicians was simply because app developers did not work closely enough with end users -- in this case, physicians.
"The real pain in the keister is ... how a physician enters information in the EHR and how clunky it is," he said. Many patients have multiple problems at the same time, and EHRs have different elements that are specific to those conditions. For example, it's sometimes hard to blend the data of a person with diabetes, renal failure and hypertension, Anders said. The EHR's elements may not be able to communicate seamlessly with each other, and the result may be data duplication.
For Medicomp and others, Anders sees a sales opportunity for care documentation modules that enhance how easily a physician can use these EHR elements. Some of that effort rests in better design, and other parts come from the ability to pull real-time data out of EHRs, he added.
Anders recalled the struggles from his own days as president of a physician group practice following its implementation of electronic health records in 2001. The practice's motive for EHR installation was to reduce the amount of building space to store paper records. But following implementation, the group's physicians discovered they could not easily document case notes in the EHR system. When those same caregivers later got the ability to document, the EHR system in turn received better acceptance from the physicians, he said.
That type of thinking will continue to play out these days for many health systems that completed implementation of electronic health records software and are now experiencing growing pains, he added.