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The challenges facing EHRs are numerous, experts have said. These challenges include information overload, lack of interoperability, poor user experience and more. But some CIOs believe that the consumerization of healthcare will bring positive change, with the result being a next-gen EHR.
"We don't have good technology on the EHR side to parse through that 50-page medical record to pull out what might be clinically relevant to the provider who's treating that patient today," said Karen Clark, CIO at OrthoTennessee in Knoxville, Tenn.
Clark explained that what often happens is a provider will receive a patient's entire chart and because they've received a patient's entire chart that supposedly means that provider is now aware of all the clinically relevant conditions of the patient.
"That's not necessarily the case and it puts clinicians in a very difficult position," Clark said.
This is because the average patient's medical record is at least 200 pages long, according to a survey conducted by GfK Roper, a market research firm headquartered in Nuremberg, Germany. The research was conducted for Practice Fusion, a cloud-based EHR vendor located in San Francisco.
Physicians are already pressed for time, Clark said. "Now you have this … enormous amount of clinical data on this patient. Do you read through the whole thing in case there's something important, hoping that you won't miss it? Do you say, as some do, 'I never read through those things, there's too much data'? Either way, it's not good."
This problem is only exacerbated by the fact that within EHRs themselves, there is poor usability, Clark said. "A well-designed piece of software guides the user's eye to the relevant information."
Given that consumer-based sites already do this, it's something many people have grown accustomed to and now expect, she added.
"You and I have both become very accustomed to having anything that's critically relevant to us presented to us in such a way that it's immediately consumable," Clark said. "That's become our expectation."
EHRs still use antiquated alert systems where so much information is stuffed into those alert boxes that people start ignoring them, she said. Caregivers develop what Clark calls "alert fatigue".
"There needs to be grades of alerts," she said. "If it's not a DEFCON 1 alert don't display it … only be alerted with critical, and I mean critical, clinical information."
Clark believes that EHR technology should focus on presenting information that is clinically relevant to the patient on that day, at that time and also present it in a way that it is unmistakable what it is.
Consumerization of EHR technology
Karen ClarkCIO at OrthoTennessee
There's been a lot of talk recently about the consumerization of healthcare and EHRs are not exempt from this movement.
To Clark, open APIs are the key to achieving an EHR technology that will truly fit into the consumerization of healthcare. She explained that having open APIs will allow various applications to connect with the EHR.
This will lead to a huge amount of development of applications geared toward certain specialties. For example, a pediatric-focused application or a joint-replacement-focused application that hooks up with the EHR, she said.
"You'll no longer have to pick one EHR that every specialist in your practice likes because that's almost impossible because the needs are so very different," Clark said. "[Providers will] be able to work around specialty specific needs or population specific needs."
Interoperability and the next-gen EHR
Another well-known issue with EHRs is the lack of interoperability.
According to the GfK Roper survey, a patient on average has their clinical data residing in almost 19 different locations. Clark said this poses a problem because even though there are tools like direct messaging and FHIR, physician practices and hospitals often aren't using these tools: "99 times out of 100 the medical records person says, 'Well, we aren't really doing that yet. Just fax it.'"
Clark explained that the work flows at many healthcare organizations have not caught up with the technology capabilities.
"It's become imperative that [vendors] figure out a new generation of EHRs," said Vish Anantraman, chief information architect at Northwell Health in New York.
In other words, a next-gen EHR, he said.
"You're going to see a lot of healthcare being delivered outside of the traditional doctor's office or hospital and so EHRs have to figure out how they adapt to these new venues of care," he said. "Next generation EHRs have to figure out … how they can be more open in their interactivity with other systems."
Regulations and hope for the future
She explained that now that many healthcare organizations have implemented EHRs and the meaningful use requirements on healthcare organizations has calmed down, the EHR market has transformed into a "replacement market" where healthcare organizations may not be happy with the EHR they implemented a few years ago. And what has changed, she explained, is that whereas a few years ago healthcare organizations would rather deal with an EHR they didn't like than undertake the challenging project of ripping and replacing, that's beginning to change and some healthcare organizations have already gotten rid of their initial EHR and are moving to a new one.
"So all the EHR vendors know that they better make their product easy-to-use," Clark said. "Because the vendor that comes to the table with a slick, intuitive, frictionless application that the clinician can interact with naturally and organically is going to win the day."
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