While there is still plenty of room for improving the usability of electronic health records (EHRs) and making them more affordable for care providers, experts are trying to get folks to focus on their future potential. The barriers to EHR implementation and interoperability are slowly coming down and once they do, vendors will start looking to add more functionalities to the systems.
It’s hard to predict which new capabilities will catch on, but potential trends include improved natural language processing, use of telehealth, enhanced clinical decision support, more mobile use, and remote monitoring.
What EHRs could look like with new capabilities
To begin with, EHRs could serve as a hub for advanced analytics—not just retrospectively, as they are today, but enabling advanced analytics and decision support capabilities.
“We have decision support 1.0 today in order sets and drug-drug/drug-allergy alerts and other alerts that the EHR has natively within the workflow,” Chase Titensor, manager at Top Tier Consulting, tells Healthcare Dive. “If you move beyond that, how do you start to incorporate the latest in research and patient outcomes for different treatment protocols, and how do you offer that up to the clinical decision-maker at the moment of decision? I think that’s a really natural extension of EHR functionality.”
Along with that comes the potential for better population health management. “We have these best of breed or standalone population health analytics tools today that can segment and stratify patient populations, but they’re reliant on data interchange from multiple sources and that becomes clunky for the clinician if you have to go to multiple applications to identify patients in a given population and track them along their pathway to wellness,” Titensor said.
By embracing population health analytics capabilities, EHRs could improve coordination among care teams and monitor and intervene with at-risk patients in a more timely fashion, he adds.
Another promising concept for EHRs is supporting virtual visits. With increased reimbursement for telemedicine services, telehealth apps are becoming more and more prevalent. However, these tools typically operate ancillary to the EHR. By incorporating telehealth capabilities natively into EHRs, usability and efficiencies would improve, Titensor says.
With the shift to value-based and patient-centric care, Titensor also sees an opportunity for embedding customer relationship management systems in EHRs.
“The EHR already is a repository for so many critical data elements about the patient.”
Manager, Top Tier Consulting
According to Titensor, it makes "a lot of sense for the EHR to incorporate traditional CRM capabilities to enhance patient engagement.” EHRs could support a variety of activities, from campaign management to outreach and multi-modal communication back to the patient as a CRM-like tool.
Natural language processing (NLP) is another way to improve workflow and increase efficiency for clinicians. While doctors complain about the time they spend entering data into EHRs, it’s critical that their notes are part of the patient record. NLP offers a way to capture the physician’s expertise in the clinical record in an efficient way.
Kyle Armbrester, chief product officer at Athenahealth, sees the electronic health record in an EHR system as a baseline for what these systems can accomplish. The company is currently pushing mobile capture applications and incorporating electronic prior authorization for prescriptions.
EHRs can also play a role in clinical effectiveness campaigns. When officials in south Florida declared an emergency situation with the Zika virus last year, Athenahealth scanned local practices that used its EHR and identified women who were pregnant or of childbearing age and alerted their physicians, helping to drive Zika screenings and promote preventive measures.
“The whole area of proactive care intervention is really exciting and can have a meaningful impact in the population.”
Chief Product Officer, Athenahealth
In addition, EHRs could be used to tackle nonhealthcare-related issues such as transportation and eating healthy by integrating with companies like Uber and Instacart, an internet-based grocery delivery service.
What will this mean for care providers
Adding these capabilities to EHRs would likely result in more one-on-one time with patients, greater clinical intelligence, and improved patient outcomes. For patients, boosting EHRs capabilities could lead to better care coordination and access to care.
Some providers and vendors are pushing for EHRs to move beyond being the be-all and end-all of health data systems to serving as an open platform that supports third-party app innovation. Most of the big major EHR vendors are supporting this move and creating standard interfaces for accessing and storing data, says Stan Huff, chief medical officer at Intermountain Healthcare. The Salt Lake City-based hospital system is working with Cerner to include third-party apps within the Cerner environment.
“It opens up a whole different world of opportunity when that interface to data is truly standardized,” Huff tells Healthcare Dive.” What it means is that third-party application developers would be able to create an application that could run without modification against any of the systems that work with those standard databases.”
That would mean providers wouldn’t have to depend on a single vendor for all their applications. Think of it as an Amazon or Apple store where providers could shop for apps that they want and choose the one that’s most cost-effective and convenient to use.
“You can see a future where people start contributing to a cloud-based set of knowledge that’s in an executable form that is incredibly powerful and useful in taking care of patients.”
Chief Medical Officer, Intermountain Healthcare
Already there’s a version of an app that helps manage bilirubin levels in newborns, Huff says. Other more complex apps are being developed to help diagnose and manage pulmonary emboli, detect and manage occult sepsis in the emergency room and manage patients with community-acquired pneumonia.
What are the limitations
With today’s limits on interoperability, it can be challenging for smaller health tech companies to integrate their digital solutions with large vendors’ EHRs, according to a recent report from Health 2.0. Most of the EHR vendors included in a survey of more than 100 small tech firms supported no integrations, and those companies that managed integration said vendors’ APIs were “not great” or “poorly designed.” The bright spot in the survey was that more than half of tech firms integrating with EHRs are attempting complex integrations.
Still, one of the biggest challenges to EHRs realizing their full potential is not the lack of innovative solution but the fact that they’re not more user-friendly.
“If we’re asking our clinicians to engage more and more with the EHR, the EHR needs to incorporate design thinking,” says Titensor. “That’s just the bottom line. It needs to become more intuitive and configurable.”