The journey of Electronic Health Records (EHR) began in the 1960s with pioneering efforts by institutions like the Mayo Clinic, despite high costs limiting their early use. By the 1980s technological advances and the Institute of Medicine took major steps to adopt electronic over paper records for enhanced EHR efficiency.
The 2000s marked a pivotal moment with the establishment of the Office of the National Coordinator for Health Information Technology (ONC) and the enactment of the HITECH Act, which of meaningful use incentives.
Today, EHRs are the backbone of patient-centric care, offering improvements such as –
- Simplified documentation
- Better care coordination
- Quality performance
- Enhancing clinical efficiency
- Improved patient engagement
However, the multitude of contextual changes, driven by perennial regulatory updates, have impeded innovation in EHR development. EHR vendors must restart their innovation engines in the face of evolving reimbursement models, improvements in interoperability standards, rising consumerism, and clinician burnout activated by the shift to Value-Based Care (VBC).
This blog will explore key EHR implementation strategies to help vendors collaborate with care providers to drive innovation in patient-centric care.
Let’s have a look at how to improve electronic health records from a clinical perspective.
EHR Implementation Strategies: Key Approaches for Successful Integration
1. Documentation
Effective documentation is crucial for maintaining clinical quality, ensuring accurate payments, and meeting regulatory compliance. Traditionally, extensive Evaluation and Management (E/M) documentation has resulted in redundant data entry. Recent CMS policies introduced in 2020 have made tactful changes to streamline these processes.
The new policies aim to minimize repetitive documentation, such as re-recording patient history, which can save time and reduce the workload for healthcare providers. Developers can incorporate new workflows and interoperability standards so that the EHR systems are consistent with the latest requirements. These policy changes can make EHR systems more efficient and user-friendly, making documentation simpler.
Use Case: A medical center adopts an EHR system that incorporates 2020 CMS policy changes, allowing nurses to reuse patient history data efficiently. This can reduce daily documentation time by 30% for more time for direct patient care.
2. Care Quality Management
Care quality management approaches can enhance the quality of healthcare services provided to patients. EHR vendors have numerous opportunities to enhance care outcomes by incorporating advanced functionalities into their products.
- Embedded Care Protocols and Clinical Practice Guidelines: The integration of standardized care protocols and guidelines directly into EHR systems can help vendors ensure that healthcare providers follow best practices consistently. This reduces variations in care and promotes uniformity in treatment across a healthcare facility.
- Alerts and Automation: Features such as automated alerts for drug allergies or reminders for follow-up visits can be added to EHR systems. These features integrate with existing workflows and support healthcare providers in making timely, informed clinical decisions.
Use Case: A health system integrates standardized care protocols and clinical guidelines into its EHR system, along with automated alerts for drug allergies and follow-up reminders. These features can improve care consistency, reduce errors, and enhance patient outcomes.
3. Minimize EHR Errors
EHR systems, while transformative for healthcare, still exhibit significant shortcomings, particularly in preventing errors caused by user fatigue. These issues can lead to serious consequences, such as incorrect medication prescriptions or dosages. To mitigate these risks and enhance patient safety, EHR vendors can implement several comprehensive strategies:
- Error Detection and Alerts: Use advanced algorithms and AI to detect potential errors in real time and provide immediate alerts to healthcare providers.
- System Updates and Backup: Regularly update the EHR system, maintain robust data backups, and have a disaster recovery plan in place to ensure data integrity and availability.
- Data Analytics: Invest in data analytics to monitor usage patterns, identify trends, and proactively resolve issues for continuous improvement.
Use cases – A Health System integrates standardized care protocols and clinical guidelines into its EHR system. The system now includes automated alerts for drug allergies and follow-up visit reminders. These features support healthcare providers in making timely, informed decisions, reducing care discrepancies.
4. Workflow Orchestration
Care teams are already feeling the strain of the cumbersome health data digitization process on EHR systems. Unfortunately, patients feel the ripples of EHR workflow complexity, too, in the form of wait times and the risk of misdiagnosis. Streamlining and harmonizing the interactions of all parties involved in healthcare—receptionists, physicians, and patients—can simplify EHR usage and improve healthcare efficiency.
EHR vendors can use automated task management, real-time updates, and user-friendly interfaces to integrate workflow orchestration into their systems.
Use case – In a hospital, an EHR vendor integrates automated task management. This reduces staff administrative burdens and streamlines patient check-ins and follow-up appointments. Physicians access updated patient data instantly. As a result, healthcare teams become more efficient, and patient satisfaction improves.
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5. Interoperability
Interoperability in healthcare is becoming a standard practice, driven by new mandates from the Centers for Medicare & Medicaid Services (CMS). One key mandate, the Cures Act Final Rule, requires seamless information exchange across various settings and entities within the healthcare ecosystem. This includes providers, care teams, ancillary services, payers, and other partners.
FHIR is the catalyst powering this change. It provides different healthcare interoperability solutions to communicate effectively so that patient data is accessible and shareable across different platforms and settings. Together with the increased use of USCDI, which is a standardized set of health data classes and elements essential for nationwide, interoperable health information exchange. The increased use of USCDI means that EHR vendors must ensure their systems can handle and exchange these standardized data sets.
The push for interoperability, powered by FHIR and USCDI, is reshaping how EHR systems are developed and used. EHR vendors must invest in the technical infrastructure and expertise required to meet these demands.
Use case – A regional health network adopts FHIR standards and updates EHR systems to support USCDI. This enables seamless data exchange across hospitals, clinics, and ancillary services. Providers access complete patient histories and treatment plans from different platforms. As a result, patient data becomes more accurate and consistent, reducing errors and enhancing healthcare delivery.
6. PDMP and ECPS Support
The Opioid crisis runs rampant to this day, in fact, 75% of drug overdose deaths in 2020 involved an opioid. The integration of PDMP requirements into EHR workflows can be an effective tool to curb it. This integration allows healthcare providers to access comprehensive patient medical histories and identify high-risk cases during consultations, improving decision-making and patient safety.
EHR developers must design and implement functionalities that enable care providers to view medical history and identify high-risk cases during an interaction. From automation to the use of alerts and notifications, EHR developers have considerable latitude to tighten the ropes around the Opioid crisis and make Electronic Prescribing of Controlled Substances (EPCS) more secure.
Since January 2021, DEA (Drug Enforcement Administration) certification has been required, making support for EPCS a priority for EHR systems. This includes ensuring that controlled substances are prescribed securely and tracked accurately, meeting regulatory requirements for secure electronic prescribing.
Use case – A doctor uses an updated EHR system with integrated PDMP access and automated alerts to identify high-risk patients during consultations. Secure EPCS secures compliance with DEA regulations. This integration improves decision-making, enhances patient safety, and reduces opioid misuse.
7. Telehealth
The outbreak of the COVID-19 pandemic has prompted the CMS and private payers to promote reimbursement for telemedicine parity. This encourages more healthcare providers to adopt telehealth. An increasing number of provider organizations will eventually jump aboard the telehealth bandwagon. EHR developers hold the magic wand of innovation to enable care providers to conduct effective tele-encounters that do not compromise the quality-of-care outcomes through EHR tweaks.
EHR developers can enhance telehealth by:
- Integrating Telehealth Tools: Embedding secure video conferencing and remote monitoring into EHR systems.
- Improving User Interfaces: Designing user-friendly interfaces for seamless telehealth sessions and patient portals for scheduling and communication.
- Enhancing Clinical Support: Implementing real-time alerts and streamlined documentation for telehealth visits.
- Ensuring Data Security: Maintaining HIPAA compliance and secure data transfer.
Use case – A rural clinic adopts a new EHR system with integrated telehealth tools. Physicians conduct secure video consultations and use remote monitoring for chronic patients. The user-friendly interface simplifies scheduling and communication through patient portals. This can result in better patient access to care and reduced travel burdens.
8. Mobility
Mobile devices are an integral aspect of the modern-day lifestyle. More patients would use mobile apps to schedule doctor appointments, manage personal health records, and medicine refills, and more if they were made available. As EHR developers strive to support seamless third-party mobile app integration, appointment management, and telemedicine functions are bound to become more convenient than previously known.
The U.S. Department of Health and Human Services (HHS) is advocating for the creation of an ‘app ecosystem’ in healthcare that highlights the importance of mobile functionality for the future of EHR development.
Use case – A healthcare provider enhanced patient engagement by integrating mobile app functionalities into their EHR system. Patients now schedule appointments and request medicine refills via their smartphones. Embracing the ‘app ecosystem’ the provider enabled seamless third-party app integration.
9. Patient Identity Management
The Cures Act Final Rule mandates several technical requirements, such as Admission, Discharge, and Transfer (ADT) notifications, which are essential and non-negotiable. These requirements improve the exchange of patient information and ensure better care coordination.
However, as provider organizations are coerced to open their gates to facilitate the exchange of patient information via APIs, security and data privacy become burning concerns.
To address these challenges, EHR developers must focus on:
- Patient Identification: Implementing robust mechanisms to accurately identify patients, reducing the risk of errors, and ensuring that the right data is accessed by authorized users.
- Authorization Mechanisms: Developing strong authorization protocols to verify the identity of users accessing the system and granting permissions based on their roles.
- Avoiding Data Fragmentation: Ensuring a unified and consistent patient record to prevent multiple versions of the same data, which can lead to inaccuracies and compromised patient care.
Use case – A hospital network enhances care coordination by implementing ADT notifications and robust patient identification measures in its EHR system. This initiative improves data accuracy and enhances patient safety.
10. Application Usability
Clinician burnout due to Health Information Technology (HIT) usage hinders the adoption of EHR systems. Issues such as inconsistent data formats, poor information architecture, clinical errors, and process inefficiencies contribute to this burnout, making healthcare providers skeptical of EHR benefits.
These issues can be addressed by establishing and following guidelines for integrating functionalities into EHR workflows. These guidelines should be incorporated into the final EHR product to streamline processes and reduce errors.
Use case – A regional healthcare system mitigates clinician burnout by revamping its EHR system with standardized data entry and improved information architecture. Clear guidelines for integrating new functionalities enhance usability and support efficient healthcare delivery.
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Conclusion
To scale up and comply with the Cures Act requirements and overcome existing challenges associated with EHR usage, HIT developers must find the ideal balance between operational expenditure and the quality of solutions developed. In this equation of ratios, focusing on EHR optimization and leveraging third-party skillsets can significantly enhance healthcare efficiency, supporting EHR developers to turn the tide in their favor.
Drop us a line at info@nalashaa.com to learn how our services supplement EHR developers’ capabilities and goals.
Puneeth Salian
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