Insight

Digitizing the Physician’s Office

What’s wrong with this picture?:

  • Physicians now spend more time focused on EHRs than communicating with the patient.1
  • Physicians typically spend more time looking at EHRs than they do paper records, meaning that time spent looking at the patient is trending downward as we continue to move away from paper records.1
  • 70% of physicians polled were unhappy with their EHR, with 72% of all respondents stating that EHRs are not providing the efficiency gains they would have expected.2
  • 61% of practicing physicians gave the health care industry a D or F for achieving interoperability, and 79% of surveyed practicing physicians suggested that information access is the most important advancement that can be made to improve care.3
  • 96% of surveyed medical students highlighted that EHR interoperability is the most important advancement that can be made to improve care.4

Given the dismal picture above, one must ask, are we heading down the right path towards a digital healthcare world?

We are in an era where we are completely overhauling the way healthcare is delivered and to expect that we could have affected a change this significant in the 10 years since President George W. Bush first called for electronic medical records is setting ourselves up for failure.  While all the required technology (and most of the connectivity) exists to enable the digitalization of healthcare, we must recognize that healthcare is notoriously slow to adopt changes for several reasons. These include:

  1. Disagreement over who should pay for health IT;
  2. The rigidity of systems reducing the efficiency of physicians; and
  3. A sense from physicians that technology interferes with human touch and personalized interaction between patient and physician.5

Even though solving all of these barriers won’t happen quickly, the healthcare industry can’t sit idle, waiting for someone else to solve the challenges providers face with technology adoption.  Instead, the healthcare industry should focus on addressing the challenges we can tackle through improved change management and focused technology enablement to help ease the frustration felt by providers and patients today and help further our cause to the ideal end state.

Change Management

No matter how large an improvement over the status quo, a system implementation project requires effective change management to drive user adoption.  A key driver of that effort is stakeholder engagement, which focuses on setting appropriate expectations for participation and outcomes, and then communicating progress against those expectations through the course of a project.  What steps can be taken to improve stakeholder engagement?

  1. Set realistic expectations for how we get to the target state. We can all envision a world where our healthcare data follows us no matter where we travel in the healthcare system, safely and securely moving between different health systems and provider networks.  In this ideal world, as a provider enters our current ailment into our universal patient record, the EHR identifies the likely cause of our ailment, based on a vast database containing information about like patients with like symptoms and root cause ailments, and recommends a treatment pathway based on both clinical guidelines and the treatment successes and failures for those like patients with like root cause ailments.  To achieve this goal, we must first build the vast database of information by collecting, aggregating, and cleansing the significant amount of data stored in various public and private systems.  Once we have that data store, we will then be able to layer on reactive and predictive analytics to achieve our goal of instantaneous clinical decision recommendations.  Many companies, including but not limited to Watson Health, IMS, Optum, Flatiron Health, and athenahealth, have stepped up to take on this challenge, and while some wins have been achieved to-date (see below), there is still a tremendous amount of work to do.  In fact, a recent Interoperability roadmap released by Office of the National Coordinator (ONC) calls for outcomes being fully realized between 2021 and 2024!6  As an industry, we must broadcast this timeline and help both providers and patients realize that we’re merely halfway through our journey instead of nearing its conclusion.
  1. “Nothing succeeds like success.”7  In addition to large patient workloads and evolving reimbursement models, physicians have recently faced the migration from ICD-9 to ICD-10 and are continuing to work toward achieving Meaningful Use requirements.  Given the amount of work on their plates, highlighting the positive impact their work is having on the overall health of the U.S. population is critical to driving future successes, as it provides a reward for physicians to continue to strive to meet Meaningful Use criteria.  Examples of these types of “wins” include an analysis by athenahealth of its EHR database following the recent National Institutes of Health (NIH) announcement of the results of the SPRINT clinical trial.  The SPRINT trial analyzed the impact of lowering systolic blood pressure targets from 140 or 150 to 120 for older Americans and found that moving to this new target reduced the risk of heart attack, heart failure, and stroke by 33% and death by 25%.8  Others, such as IBM Watson’s Explorys and Phytel, are partnering to develop registries from Explorys’ 55 million+ patient-record database and then drive patient behavior that results in better health outcomes and reduced costs.10  None of these activities would be possible without the work HCPs have done to date in capturing patient information in EHRs.

Technology Enablement

While helping HCPs better understand the value of their efforts should help drive positive behaviors, there are simple steps the healthcare IT industry can take to reduce the burden HCPs face when implementing technology because we know that when deployed effectively, technology can help physicians access important information quickly, connect with patients, and improve outcomes.11

  1. Create the right User Experience. In a 2014 survey of 18,500 HCPs’ satisfaction with EHRs, Ronald Sterling CPA, MBA, and Principal of Sterling Solutions in Silver Spring, Md., states that “EHR vendors have been overly focused on meeting the demands of meaningful use rather than addressing the focused needs of doctors.”12  This sentiment was echoed by Scott Wallace in a 2014 blog post on HealthAffairs.org, stating that “most EHRs were designed around corporate priorities—billing and high-level record keeping—and their support of the corporate strategy comes at the expense of the service lines [aka clinicians].”13   As a result of these corporate strategies, physicians are often queried for irrelevant information that interferes with care, instead of enhancing it.  EHR vendors must increasingly focus on delivering configured solutions that support the various clinical pathways addressed by specialties to increase efficiency for physicians at the point of care, in addition to addressing Meaningful Use, Stage 3 requirements.  This focus can, and should, include leveraging learnings from other industries that excel in user experience (i.e., retail) to create user interfaces (UI) and process flows that are simple, easy-to-use, and are configurable to meet physician needs.  Wallace also recommends that “care delivery organizations should invest in clinician-assisted designers to better articulate information needs.”13 
  1. Build the foundation for interoperability. As noted above, most physicians and medical students feel that access to patient information is the biggest challenge they continue to face in improving healthcare.  With that in mind, the healthcare IT industry must find a way to reduce interoperability concerns.  Three options exist to solve this problem:
  • Creation of a universal health record
  • Standardization on a single EHR platform across all care settings in the U.S.
  • Creation of a robust market for translation of information between systems

While creation of a universal record may be the most elegant solution to the interoperability challenge, the investment required in both time and money to develop and maintain that record is likely too large to be successful in the short or medium term.  Likewise, while we are likely to see consolidation in the EHR market, to think that the market will consolidate down to a single vendor seems highly unlikely.  As a result, our best option is to find an infrastructure to support the translation of information.  The HITECH act in 2009 established government funding for many non-profit Health Information Exchanges (HIEs) and sustained them through the early part of the decade.  However, HIEs face many challenges in today’s environment, including:

  • Slow adoption by clinicians and health plans
  • Lack of standards
  • A rapidly changing technology environment that creates disruption from non-standard healthcare IT providers
  • No alignment of incentives for providers or closed network EHR companies to invest in technology from which its competitors will benefit
  • An inability to identify sustainable funding sources outside of federal and state funding13

While the rapidly changing environment has the potential to introduce new competitors or new models into the market, it is the last challenge, lack of funding, that is the biggest short-term difficulty and must be overcome through a primarily private sector approach, since much of the public grant funding offered at the national, state, and local level to stand up HIEs has been exhausted.14

  1. Secure patient data. While the debate about who owns patient data (the patient or the provider) still exists, one thing is very clear: if the owner of patient data doesn’t trust that the data is going to be secure outside his/her sanctioned systems, he/she is not likely to be an active supporter of sharing that information.  Instead of shelling out more than $37 billion to deal with cyberattacks and data breaches, such as what happened between January and August 2015, the Healthcare Industry needs to focus on eliminating the data breaches.15  EHR vendors, health systems, HIEs, and every other player in the healthcare systems must work to eliminate these breaches through maintaining secure storage and transmission of data, as well as enforcing effective password and device management by people who have legitimate access to healthcare data, since many breaches still occur as a result of lost/stolen devices with unencrypted data.16

As the health care industry continues to strive to achieve the vision of a fully integrated network of care across live and digital channels, we must remind ourselves that we must get all participants, including providers, health systems, heath IT vendors, payers, and patients, walking in the same direction before we can begin running.  By helping each of the participants in the process understand their role, and the timeline to achieve our vision, we can make steady progress towards our goals.

To find out how Vynamic can help your organization develop and execute on a roadmap that drives towards an interconnected healthcare world, click here.

End Notes
  1. Weinburg, Jeffrey M., MD. “Face Time” The American Journal of Orthopedics. August, 2014.  Downloaded November 20, 2015: View in Article
  2. American College of Physicians (ACP). “Survey of Physicians Shows Declining Satisfaction with Electronic Health Records.” August 10, 2015.  Downloaded November 27, 2015. View in Article
  3. athenahealth. “UPDATE — Epocrates’ Survey Finds 95 Percent of Physicians Have Experienced Difficulty Delivering Care Due to Inaccessible Patient Records.”  April 13, 2015.  Downloaded October 14, 2015. View in Article
  4. Athenahealth. “What do medical students think about health care today?”   April, 2015.  Downloaded October 14, 2015. View in Article
  5. Pearl, Robert. “5 Things Preventing Technology Adoption In Health Care.”    September 11, 2014.  Downloaded November 28, 2015. View in Article
  6. The Office of the National Coordinator for Health Information Technology (ONC). “Connecting Health and Care for the Nation A Shared Nationwide Interoperability Roadmap.”  October 2015.  Downloaded October 20, 2015. View in Article
  7. (n.d.) McGraw-Hill Dictionary of American Idioms and Phrasal Verbs. (2002). Retrieved November 27 2015. View in Article
  8. National Heart, Lung, and Blood Institute. “Landmark NIH study shows intensive blood pressure management may save lives.”  September 11, 2015.  Downloaded November 29, 2015. View in Article
  9. Athenahealth. “Photo Release — 9 Percent of Patients Over 50 Potentially Eligible for More Aggressive Blood Pressure Treatment.”  September 21, 2015.  Downloaded October 1, 2015. View in Article
  10. IBM. “Phytel Acquisition.” May 3, 2015.  Downloaded: November 4, 2015. View in Article
  11. Krueger, Alyson. “Six Ways Technology is Improving Healthcare.” Business Insider.  Dec 20, 2010.  Downloaded December 3, 2015.   View in Article
  12. Chesanow, Neil. “Doctors Rate Their Top EHRs: Some Complaints, Some Praise.”    July 15, 2015.  Downloaded: November 12, 2015. View in Article
  13. Wallace, Scott. “The Strategic Challenge Of Electronic Health Records.”  Health Affairs Blog.  December 16, 2014.  Downloaded: November 27, 2015. View in Article
  14. Greenberger, Mari. “12 Things You Should Know About Health Information Exchanges.”  July 6, 2015.  Downloaded: November 12, 2015. View in Article
  15. ayanthi, Akanksha. “Cost of data breaches in 2015 surpasses overall federal IT investment.”  Becker’s Health IT & CIO Review.  August 10, 2015.  Downloaded November 13, 2015. View in Article
  16. Ponemon Institute. “Criminal Attacks Are Now Leading Cause of Data Breach in Healthcare, According to New Ponemon Study.”  May 7, 2015.  Downloaded November 28, 2015. View in Article
See All Notes