Biggest EHR challenges for 2018: Security, interoperability, clinician burnout
From left, Michelle C. Lardner, RN, Kris K. Wilson and Matthew Ernst
Moving into 2018, hospitals and health systems continue to face many challenges in implementing, maintaining and upgrading their electronic health record systems. These challenges range from technical to security to strategy to human interaction.
Kris K. Wilson, chief information officer at Hilo Medical Center, a Hawaii hospital that has achieved the top HIMSS Stage 7 ranking for its IT work, says cybersecurity will be a top challenge hospitals must face in 2018 when it comes to their EHRs.
"As EHRs mature and collect vast amounts of data, keeping this data safe as adept cybersecurity threats increase must remain at the forefront," said Wilson. "Educating staff on the proper use of hospital systems and placing safeguards within your EHR to limit the amount of data accessible is a good start to overcoming this challenge."
To staff, having only limited access to Internet sites and applications may seem restrictive, but CIOs should see this measure as necessary, she added.
Another major challenge facing EHRs in 2018 is the continued focus on interoperability. Systems need to be able to talk with one another to successfully gain the complete picture of a patient as possible. But as hospital and health system CIOs have discovered over the years, that’s a tall order. Technology and strategies exist to help tackle this challenge, however.
"The major challenge that all of us face is the development of interoperability," said David Ratto, MD, a pulmonary and critical care specialist and hospitalist at Methodist Hospital of Southern California who has been directly involved with the hospital’s EHR. "Whether we are trying to accomplish meaningful use or improve the overall care of our patients, we need improved functional interoperability. Data must be available and needs to be seamlessly transferred from one source to the next."
How to take on the challenge of interoperability? Ratto said he'd like to see a scale-back on Stage 3 meaningful use – except for the interoperability segment.
"That should not be pushed out to later dates, and in fact it should be mandated that all vendor products meet interoperability standards," he said. "Some of the standards definitely should be made simpler."
On the interoperability front, Mustafa Ozkaynak, assistant professor in the college of nursing at the University of Colorado Anschutz Medical Campus, pointed to the need for hospital and health system EHRs to play nice with information systems from other types of care provider locations.
"EHR systems should be open to accept data from outside resources such as daily living settings and nursing homes," Ozkaynak said. "As more and more health-related activities take place in daily living settings – home, work, restaurants, etc. – EHRs should be able to use the data collected in daily living settings."
To overcome this challenge, hospital and health system CIOs and other executives should develop strategies for how data from nursing homes, for example, can be integrated into their EHRs, he said.
“The starting point should be reviewing current interoperability strategies and revise them to be more inclusive so that nursing home data can be utilized by hospitals,” he added.
On another front, there is the rise of value-based care in the healthcare industry. And this change in healthcare reimbursement from volume to value will have an impact on EHRs.
"Most EHRs continue to be cumbersome with features driven toward reimbursement for which they were developed, rather than toward value-based care, and that focus is shifting,” said Kurt Hegmann, MD, director of the Rocky Mountain Center for Occupational and Environmental Health at the University of Utah and a partner with Kaiser Permanente, working on their EHR.
"CIOs and other executives should put themselves in the physician’s shoes; spend a day following physicians and see how they work with their EHR tools, understand the pain points, and hear their suggestions on improving value-based care."
Looking forward a bit, Michelle C. Lardner, RN, deputy CIO, clinical informatics, in the department of clinical research informatics at the National Institutes of Health, said genomics functionality in the EHR is not necessarily a major challenge at most hospitals going into 2018; however, as this practice grows, the need will show itself
"For those organizations that offer precision medicine, the need is certainly there," Lardner said. "That is the challenge. Data such as family history and genetic test results become information and knowledge that can tailor patient treatment and could improve outcomes."
This data must be readily accessible by the nurses, doctors, geneticists and researchers that practice in this field. "We championed this requirement and partnered with our vendor to develop the integrated tools we need for our clinicians and researchers," she added.
And finally, there is the age-old problem of information overload and clinician burnout with EHRs. Technology teams need to get a grip on this challenge to help clinicians do their jobs without tiresome and tedious technical work.
"EHRs are great for gathering information into one tool, but the workflows to manage this are sometimes confusing and overwhelming for the staff, causing burnout," said Matthew Ernst, director of training, documentation and support for digital innovation and consumer experience at Thomas Jefferson University. "When staff get overwhelmed and start to feel burnout, their productivity goes down and possible patient safety issues can creep in."
One of the ways to overcome this challenge is to fund a team that is dedicated to working with the staff to help them understand the workflows, build out shortcuts, and report back to the EHR analysts on any issues – call this the EHR consumer experience team, Ernst suggested.
"This team would partner with the staff, super-users, and designated department contacts, and would give the staff a sense of ownership into its use," he explained. "The goal would be for the staff to become more proficient in its use and be freed for additional tasks."
Revenue recovery can be a logical outgrowth of this approach, he added. Executives can set up a few metrics to measure this.
"One could be the number of patients a doctor sees in a day," he explained. "For example, a doctor becomes more proficient in documenting in the EHR and is able to see an additional patient a day, three days a week. For a hospital with 500 physicians – 1,500 patients a week – 78,000 patients a year. There would be other revenue opportunities with these patients."
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