Innovation and Electronic Health Records: Can They Get Along?

Innovation and Electronic Health Records: Can They Get Along?

Electronic Health Record (EHR) systems are fundamental and necessary for any successful health system. They achieve orders and accumulate and trend results; they assemble nursing and provider notes that beset the patient story within and across episodes of care; they capture charges and automate the revenue cycle management functions. Most EHRs now even have a patient-facing interface where patients can communicate with their providers, view test results and schedule visits.

Initially conceived and designed as a basic transactional system, EHRs now serve many health system operations well. But, they're very complicated, multi-purpose tools constructed to serve a good range of sorts of health systems and healthcare provider users. Arguably, thereupon complexity, they aren’t as sophisticated or nearly as intuitive as your favorite website or app.

While health systems strive to augment the ease, usability, and intuitiveness, add functionality and transform the way the EHR is employed to deliver better care, there are several factors that are becoming within the way:

• All EHRs and EHR versions have different levels of functionality. While healthcare it's many standards, there are highly variable interpretations and implementations of these standards. If you've got seen one EHR, you've got seen one EHR.

• Many health systems and providers are still battling simply implementing basic functionality due to cost, resources and/or competing priorities.

• With different levels of maturity of functionality and/or adoption, rock bottom common denominator between EHRs and health systems often defaults to a really basic level of functionality – making consistent and advanced integration difficult.

• Healthcare, as an industry, is undergoing significant change leading to mergers, acquisitions, and non-traditional partnerships, all of which can require EHR consolidation and/or implementation efforts. These struggles often take importance over implementing advanced, innovative functionality.

• EHRs are highly proprietary, and it's not necessarily in their financial best interest to facilitate interoperability with other companies.

The bottom line, there's still a quiet little bit of basic blocking and tackling happening in healthcare IT. So, given this reality, what are those health systems put on transformation and innovation to do?

Many organizations that want to innovate don’t have the resources to design and build EHR-based solutions themselves, so they are beholden to the EHR vendor building and releasing solutions

There are a few models that have emerged:

1. Innovate around the EHR

There are many organizations that have found out innovation centers where new ways of working are ideated, designed and implemented. Often, the mixing with the EHR isn't considered, or it's considered but the planning and build of the EHR functionality to support the new processes is just too difficult. Solutions are then built outside and round the EHR. While this might be an excellent way of generating and trying out new ideas, the very fact that the new process and tools aren't integrated with the EHR, and thus the provider workflow, may limit usability and scalability, and ultimately, sustainability. In many cases, these ideas find you dying within the innovation lab or after a limited pilot.

2. Implement and innovate solutions within the EHR when the EHR vendor discharges the functionality

Many organizations that want to innovate don’t have the resources to style and build EHR-based solutions themselves, in order that they are beholden to the EHR vendor building and releasing new, more advanced solutions. While this works within the end of the day, the discharge cycle for the new functionality might not meet organizational timeframes, and good ideas may need to be deferred or abandoned completely.

3. Innovate, use the EHR vendor solution when possible, and integrate with innovative third-party solutions also 

If a health system desires to innovate and is convinced that EHR integration may be a must-have, a hybrid model exists where the health system can believe the EHR vendor for advanced solutions because of the preferred path for innovating. But, where that option doesn’t exist, the health system can partner with innovative third-party vendors and integrate the answer with the EHR.

With this third model, the innovation agenda is often moved forward during a timelier manner and during a way that's scalable, and hopefully, sustainable. If a health system does prefer to move forward during this fashion, there are several factors to consider:

• Stay current with the EHR releases and ensure there's a process for turning on new functionality when it's released by the seller. This is often a foundational element. If the EHR isn’t current, it's getting to be difficult, if not impossible, to execute.

• Specialize in the way to get data in and out of the EHR effectively. This will mean HL7 interfaces, FHIR, or vendor-supported web services and APIs. When integrating with third-party vendors use standard integration technologies and have internal staff members who understand the technologies. Avoid custom programming, unless all other options are exhausted.

• Identify physicians and nurses who are material experts and familiar enough with the EHR to talk to what innovations are needed to enhance the healthcare delivery process. Pair up engineers with the clinicians throughout the whole process, ideally before the primary line of code is written, to make sure the innovations are truly getting to add existing and new clinical workflows. Make sure that the mixing between the EHR and therefore the third-party tool is intuitive and seamless. During a perfect world, the clinicians don’t even know the difference between the EHR and third-party tool – it just works.

Implementing and maintaining EHRs is difficult. Innovating and integrating new tools and functionality into the EHR is even harder. But, it is often and has been done and is important if the EHR is to be truly functional and intuitive. Understanding what the organization’s goals are around innovation, tolerance for change and what the interior IT staff core competencies are will help determine what model of innovation and EHR integration will work best.

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