While medicine advances, until recently its information management was stuck in the past – a patchwork of data and paper records scattered among multiple providers. The side-effect was antiquated record-keeping and less than ideal healthcare for millions of people. Medical Health Records (MHRs) are the 21st Century’s solution for 20th Century medical records.
This outdated data patchwork caused problems including slower treatment and wasted repeat work. It was an IT infrastructure overdue for an upgrade – over the past decade providers have been migrating to MHRs.
One of the fastest growing trends in technology is Health Informatics and it’s been spurred on by U.S. federal laws including the U.S. American Recovery and Reinvestment Act’s HIGHTECH Act, the Affordable Care Act and the Medicare Access and CHIP Reauthorization Act.
These laws included a national goal of promoting the adoption of Electronic Health Records (EHRs).
The idea of EHRs are relatively new. The terminology for this medical records format originated in 1991 at a division of the National Academies of Sciences, Engineering and Medicine. The phrase Electronic Health Record, or “EHR”, was adopted 12 years later as part of a broader national policy to improve health care delivery.
In 2005, President Bush, in a speech at the NIH, said that “We’ve got a 21st century medical practice but a 19th century paperwork system.” – it was estimated in 2009 that less than 8% of hospitals used EHRs. President Obama, as part of a government drive to fund “shovel ready” infrastructure investments, set in motion the promotion of EHRs.
Healthcare policy non-profit organization The Commonwealth Fund summarized the benefits:
“Hundreds of studies of EHRs and decision support systems across the country have demonstrated the benefits of such tools.
EHRs can slash drug-drug interaction rates, decrease mortality rates among the chronically ill, cut nurse staffing needs, and lower costs.”
A Key Federal Health IT Policy For Using EHRs: “Meaningful Use”
Part of the HITECH Act required all healthcare professionals to demonstrate “meaningful use” of these new data formats in exchange for financial incentives (e.g. maintaining Medicaid and Medicare reimbursements).
What does the term “meaningful use” mean for providers and patients?
What are we supposed to expect from Electronic Health Records providing “meaningful use”?
Improving quality, safety, efficiency, and reducing health disparities
Engage patients and families in their health
Improve care coordination
Improve population and public health
Ensure adequate privacy and security protection for personal health information
Federal EHR policy initially relied on financial incentives (via the “Centers for Medicare & Medicaid Services (CMS) EHR Incentive Program”) to promote the adoption of EHRs by providers. It then penalized for slow or non-adoption of EHRs through reduced Medicare reimbursements.
An administrative entity – The Office of the National Coordinator for Health Information Technology (“ONC”) – oversaw a EHR Software certification program to ensure that EHR software usability met the government’s minimum criteria to provide “meaningful use” for providers.
The ONC is the ”federal entity charged with coordination of nationwide efforts to implement … advanced health information technology and the electronic exchange of health information”. This entity “is a resource … to support the adoption of health information technology… improve health care….[as part of] the Office of the Secretary for the U.S. Department of Health and Human Services (HHS).”
The ONC’s official definition of EHRs:
“An electronic health record (EHR) is a digital version of a patient’s paper chart.
EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users.
While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care.”
The ONC’s definition of what EHRs should do and provide:
“EHRs are a vital part of health IT and can:
Contain a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results
Allow access to evidence-based tools that providers can use to make decisions about a patient’s care
Automate and streamline provider workflow”
EHRs key value: a digital format shareable among healthcare providers
Documents can be created and managed by providers in a format which can be shared with others across more than one health care organization.
EHRs are built to share information with other health care providers and organizations
– such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics –
so they contain information from all clinicians involved in a patient’s care.”
What The “Meaningful Use” Requirement Means For EHRs
Benefits Providers and Patients Expect From EHRs
A List via ONC includes:
NOTE: Two health IT phrases used interchangeably BUT are very different: EHR vs. EMR
An Electronic Health Record, or EHR, should have “everything” in terms of your healthcare history – it’s a real-time digital kitchen sink which holds all healthcare histories, including diagnoses, immunizations, labs, and more. All of this data should be shareable between different providers.
EHRs are compliant with federal mandates and regulations for Medicare and Medicaid payments.
An Electronic Medical Record, or EMR, is an electronic version of the records in your doctor’s office – it might be used only inside one provider’s office. It’s basically an updated version of the paper files any medical practice might keep on their patients. It might not be in a format which is easily shared with other providers – and may not be in compliance with federal standards for digital medical data.
Progress towards EHR adoption has been significant since the HITECH ACT’s start in 2009:
“Data from the US Department of Health and Human Services show that in 2017, 96% of hospitals and 86% of physicians’ offices in the United States had access to electronic health records…
A 2019 poll by the Henry J. Kaiser Family Foundation, a non-profit health-care advocacy organization in San Francisco, California, found that 45% of US citizens think that electronic health records have improved the quality of care, with only 6% reporting a decline.”
How are EHRs created and how are they shareable? What is being used by healthcare providers to comply with ARRA and ACA regulations? It is SOFTWARE which makes this possible.
For data and IT Infrastructure needs there are tech companies that will fulfill this demand. These companies had to create the solutions that were compliant with federal regulatory requirements.
Which are some of the SOFTWARE companies providing EHR products?
Epic: Specialized in large medical groups, hospitals and academic medical institutions
Cerner: Health IT solutions and largest provider for inpatient care systems
Carecloud: Software provider with awards for its health IT software
Athenahealth: Cloud provider of EHR and practice mgmt for large medical groups and hospitals
GE Centricity: GE subsidiary whose focus shifted from enterprise to smaller medical practices
Allscripts: Focused on small to medium medical practices
A handful of companies hold close to an 80+% market share of certified Health IT modules – meaning that they dominate EHR market share.
(Chart source: Kaiser Health Organization)
Some of the world’s largest technology companies are also involved in this space, including Amazon, Apple, and Google. Amazon’s AWS had a deal with Cerner, Apple had pilot programs with a few dozen health systems for “Apple Health Records”, and Google worked with the American Medical Association (AMA) to encourage hardware and software development, as well as a Google Healthcare API.
The sharing of personal information does raise a concern: privacy
How do patients feel about the sharing of personal medical information and if its management is private and safe?
It turns out many people are confident that their personal health information is private and safe.
“An ONC data brief shows hospitals most often use EHR data to support quality improvement, monitor patient safety, and measure performance… 82% of hospitals used EHR data to support quality improvement from 2015 to 2017…”
Considerations medical providers think about when adopting an EHR solution include:
What is involved in moving records to an EHR solution – a migration of information & training
What can and can’t be done with an EHR solution in terms of migration and what follows
Even with the adoption of EHRs over the past decade the reality is a lot more has to be done
There are challenges to solve to make real the potential of connected shareable medical data, including provider error and fatigue.
Tech services will be needed to help medical providers invest in and maintain Health IT infrastructure.
Modern Health IT can be labor and time intensive and cause medical provider fatigue and errors.
“A study of 142 general practitioners in Wisconsin found that, on average, their working day lasted 11.4 hours, which included 5.9 hours using an electronic health-record system. Of the time spent on the computer, 44.2% involved clerical work and 23.7% was devoted to managing inboxes. It’s no wonder that a 2015 study found that more than half of US physicians showed one or more signs of burnout.”
Health IT fatigue comes in many forms, including the risk of increased dangerous errors due to over-reliance on imperfect reporting systems – providers may not double-checking data as they would have done when they worked with only paper records.
There is also the opposite problem of “alert signal” fatigue from current health tech’s ability to alert on multiple patient issues quickly and constantly which causes over-worked providers with limited attention spans to ignore some alerts.
Kaiser Health News noted that “60 percent of participants in Stanford Medicine’s 2018 National Physician Poll said EHRs had led to improved patient care. At the same time, about as many (59 percent) said EHRs needed a “complete overhaul”.
According to the Harvard Journal of Law & Technology:
“Despite the difficulties in implementing EHRs, policymakers might presume that at least the incentive payments solved one source of concern: cost.
Unfortunately, some recent data indicates that cost remains substantial despite financial assistance. A literature review found that costs vary widely, with the EHRs causing anywhere from a 75% decrease to a 69% increase in operating costs.”
The biggest objective of EHRs is interoperable data – which conflicts with economic incentives of various medical providers and businesses:
“The notion that one EHR should talk to another was a key part of the original vision for the HITECH Act, with the government calling for systems to be eventually interoperable.
What the framers of that vision didn’t count on were the business incentives working against it. A free exchange of information means that patients can be treated anywhere.
And though they may not admit it, many health providers are loath to lose their patients to a competing doctor’s office or hospital. There’s a term for that lost revenue: “leakage.” And keeping a tight hold on patients’ medical records is one way to prevent it.”
Before it seems as if the full potential of EHRs won’t happen, it’s more likely that its current short-comings will be solved.
The federal government policy of broad adoption of EHR has been almost achieved. What follows will be the improvement and growth opportunities in coming years. There will be upgrades.
The goal of interoperability requires overcoming various technological, economic, and regulatory barriers. There means that a lot more work will be needed from tech companies – and new ideas.
What kind of technology can we expect soon and next?
The potential of “the Cloud” and the “open source software” movement which enables interconnected and shareable data – of interoperable medical records – can support the rise of modern healthcare.
The decade-long rollout of EHRs has not been perfect but there are more improvements coming to enhance shareability, reduce stress and waste, and most of all prevent harmful errors.
Mobile solutions. Both providers and patients are increasingly able to use their smartphones to be connected, communicate and access services and information. AI and Voice Recognition prototypes will support in-room sensors and medical devices. This could reduce the errors, fatigue and hours spent for data entry thanks to upgrades of medical devices and hospital ward sensor technology. Virtual assistants would be used by providers using Epic software would use voice to work open patient health and lab data. Data Analytics and algorithms will help providers sift through and connect all of a patient’s data. These kinds of technologies will change how “paperwork” gets done, save time and reduce stress.
Healthcare means that an ocean of data grows larger by the minute.
It has to be hosted and managed. Help will be needed for choosing the right solutions, with migration of data records, formatting and customization.
Medical providers already have so much to do for patients. The more that can be done to take non-medical work out of the hands of providers, the better. This is where tech service providers come in.
Consulting for solutions, migration, database design and management, software integration, hosting services are just a few of the issues.
This is where Osolabs can help: technical consulting is what we do.
If you have any questions pleas feel free to reach out and contact us.