EHRs: From data repositories to powerful workflow engines

While EHRs are nothing new, many clinicians continue to struggle with them and dislike the accompanied administrative work. For every hour a physician spends with a patient, he or she might spend an additional two hours tapping data into an EHR or completing other administrative tasks.¹ Some physicians end up completing their EHR work at home after hours—something one organization dubbed “pajama time,” according to our report on physician-alignment strategies.

Driving change through physician engagement

To dig deeper into physician attitudes related to EHRs, the Deloitte Center for Health Solutions surveyed 624 US primary care and specialty physicians. More than half (58 percent) said they see clinical documentation as an area in need of improvement, and 36 percent saw documentation as a daily task that is ripe for better automation. These tasks include charting, capturing visit notes, data entry, and inputting information to meet administrative billing requirements.

Although physicians are important stakeholders, some of our survey respondents said they felt like passive participants when it came to EHR improvement efforts. Only 34 percent of all physicians that we surveyed said they had been asked by their organization or an EHR vendor to provide feedback on EHR enhancements. Interestingly, 44 percent of primary care physicians said they had been asked to provide feedback. Primary care physicians were early adopters of EHRs and many of them have more experience with the technology. This could be because the Medicare and Medicaid EHR Incentive Programs, which provide financial incentives to adopt and demonstrate meaningful use of EHRs, were most applicable to primary care physicians.

Health systems should consider ways to solicit feedback from their physicians. According to our research, there is a link between inviting feedback and sustaining engagement. About half of physicians who said they were not asked for feedback also said they were unaware of any efforts to improve EHRs. Among the physicians who were asked to provide feedback, just 16 percent said they were unaware of improvement efforts. While feedback won't necessarily lead to more functional EHRs, it could help the health system's informatics teams understand some of the challenges physicians encounter—and develop comprehensive solutions.

Improved interoperability could keep the trains running

More than 60 percent of the physicians we surveyed agree that EHR systems need to be interoperable. But this is a complex issue with no easy solution. As many health systems have grown through mergers and acquisitions, they have been left with a variety of EHR systems that often can't talk to each other.

The need for interoperability is not unique to health care. Early in this country's history, railroads operated regionally and there was no standardized gauge for the tracks. To build an interoperable intercontinental railway system, the nation's railroad operators had to agree on the gauge of track and types of cars that would be used. In some areas, miles of track had to be replaced with the standardized version.²

Similarly, hospitals and health systems might need to move toward a standardized EHR platform or connect multiple platforms through interface engines. Internal and external stakeholders will likely need to come together and agree on standardized governance and documentation requirements. We appear to be heading in this direction.

The 21st Century Cures Act of 2016, for example, requires the US Department of Health and Human Services (HHS) and the Office of the National Coordinator for Health Information Technology (ONC) to improve the interoperability of health information. Over the next few years, ONC is expected to establish a Trusted Exchange Framework and Common Agreement to improve data sharing across disparate health information networks.

Improvements in interoperability could help reduce duplications and limit the need to chase down patient records. This would likely lead to more accurate and complete clinical information. Rather than relying on patients to relay information, clinicians could more easily access the original sources (e.g., procedures, tests results, medication/dosages).

It wasn't long ago that patient medical records existed only as paper documents in color-coded folders housed in massive metal filing cabinets. Efforts to move away from paper records began in the early 1960s, and Lockheed Corporation is credited with developing the predecessor to the modern EHR in 1971.³ In the decade that followed, academic medical centers developed their own variations, and the federal government implemented its Decentralized Hospital Computer Program for the Department of Veterans Affairs.⁴

Many hospitals have made substantial investments in data and operations-management systems for EHRs, supply chain, and revenue-cycle functions. Health system leaders should consider devoting resources to train and retrain clinicians on how to use EHRs effectively. EHRs that serve as powerful workflow and analytics engines could be particularly important as health systems move toward value-based care. The technology behind EHRs is complex and not always easy for some clinicians to use. Creating a culture where clinicians are rewarded for seeking technical help could be an important step forward.

Footnotes

1. Annals of Internal Medicine, Putting patients first, May 2, 2017 (http://annals.org/aim/fullarticle/2614079/putting-patients-first-reducing-administrative-tasks-health-care-position-paper)
2. Library of Congress, The Transcontinental Railroad (https://www.loc.gov/collections/railroad-maps-1828-to-1900/articles-and-essays/history-of-railroads-and-maps/the-transcontinental-railroad/)
3. The American Health Information Management Association, EHR Evolution: Policy and Legislation Forces Changing the EHR (http://library.ahima.org/doc?oid=105689#.W6u2JHOWxpw); American Medical Association, Development of the Electronic Health Record, March 2011 (https://journalofethics.ama-assn.org/article/development-electronic-health-record/2011-03)
4. US Department of Veterans Affairs, History of IT at VA (https://www.oit.va.gov/about/history.cfm)

Steve Burrill, a partner with Deloitte LLP, is the vice chairman and national sector leader for Deloitte's Health Care practice. He leads a multi-disciplinary team who serves clients through consulting, advisory, audit, and tax services. Steve also leads the overall strategic direction and market eminence of the health care providers sector, including client-facing leaders' development and succession, business development efforts, and cross-functional go-to-market strategies. With more than 33 years of experience, Steve has served clients across the health care spectrum–complex large systems, academic medical centers, children's hospitals, and single location entities–and has led large transformational projects involving acute care hospitals, ambulatory operations, clinics, and physician practices.

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