Don't Miss a Beat

Reflecting on health IT’s nagging challenges — and where to go from here

Written by Linda Fischer, Vice President of Product Strategy at DrFirst | December 13, 2018

December 18, 2018

As I look back on my career in healthcare and the progress that we have made in health IT, I feel as though I have seen and been a part of it all.

I’ve had a front-row seat over the years, watching the evolution of technology first as a hospital CIO for 21 years, till today, as an active participant in helping to create solutions that are more sophisticated and hopefully more productive than ever.

In the early 2000s, we began implemented electronic medical records (EMRs) that were primarily designed to satisfy billing needs. In less than 20 years, the systems of today are light years ahead, due to continuous adaptions and updates to address new patient care and reimbursement models and to satisfy ever-changing government regulations and reporting requirements. Back in the day, my primary objective when managing IT implementations was to successfully drive improvements in patient safety and advance clinical and financial efficiencies.

These days, it is troubling that we still haven’t fixed many of the problems that have been lingering over the last two decades despite all of our technological advancements and achievements. Even worse, brand new challenges are beginning to pop up as a side effect of some of our original “fixes.”

As we move into 2019, I have compiled a short list of some of the biggest, nagging challenges that continue to impact our industry.

Technology Incompatible with Industry Evolution

When we first installed EMRs, we were confident they would solve many problems –such as avoiding preventable medication errors because prescriptions were legible and avoiding potential adverse drug events (ADEs). However, as we began implementing EMRs, the healthcare landscape began to shift from episodic care quarterbacked by the primary care provider, to a new model that relied on integrated care teams across the healthcare continuum.

In the “old days” family practice doctors, who had an ongoing relationship with the patient, were notified any time a patient was admitted to the hospital. The doctor would conduct hospital rounds every morning and review the latest updates with nursing and other staff. Whereas in recent years, the patient care team model relies on hospitalists to manage the care of hospitalized patients. These hospitalists don’t have a previous relationship with the patient and therefore rely heavily on medical record details from the patient’s other physicians.

Unfortunately, the EMRs we implemented 10 or 15 years ago created information siloes. They were not built to address newer communication demands, nor to facilitate easy sharing of patient records across disparate EMRs and health systems. Moreover, they prevented physicians from gaining easy access to essential clinical information that could advance the efficiency and quality of patient care.

On top of the evolution of healthcare, IT vendors are unable to focus their efforts on ways to make communication and workflows better, because they are forced to prioritize development efforts to give clinicians the ability to check the right regulatory boxes for maximum reimbursement.

Regulations Create New Challenges

Providers must adapt continuously to new rules that are designed to improve communication between care team members and advance the quality of care. Despite the noble intent of such initiatives, many of these regulations have failed to solve the targeted problem and instead create new headaches.

For example, Meaningful Use requires providers to generate continuity of care documents (CCD or consolidated clinical document architecture C-CDA) when transitioning a patient’s care. CCDs include a raft of patient information including relevant administrative, demographic, and clinical facts. Often, a single CCD can consist of pages of details. Often, they are ignored because clinicians don’t have time to weed through extensive documentation to find the relevant information they need.

The irony is that physicians do want specific patient details, especially during transitions of care, but due to the inefficiencies of CCDs, physicians frequently fall back on traditional methods such as phone calls and faxes.

What is the Solution?

To achieve clinical and financial success under new value-based care models, we must achieve interoperability success. Systems need to share information accurately and efficiently to advance cost-effective delivery of quality patient care.

Unfortunately, full-scale interoperability between all providers and different EMRs is likely to take several more years. In the meantime, as we wait for EMRs to catch up, we need to equip providers with easily adaptable solutions that address the pain points, without requiring organizations to rip and replace their legacy EMRs.

For example, stakeholders could use secure messaging apps that allow providers to share the most pertinent parts of the CCD with other care team members within the physician’s workflows. These apps can also help health systems achieve value-based care success by improving communication between patients and physicians and engaging patients in their care and wellness. Some of these tools allow care team members, patients, and their families to securely communicate, receive updates, ask questions, and avoid the inefficiencies of phone tag and voice messages. When patients can communicate directly with their care providers, they can make more informed decisions about their care and treatment.

Health IT leaders still have work to do when it comes to maximizing the efficiencies of our systems. However, as we move into 2019, I am encouraged by our success so far and look forward to seeing even more solutions that drive improvements in the quality of patient care.

© Copyright ASC COMMUNICATIONS 2018.

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