Hospital and health system execs discuss the hurdles they’re facing as
they move into the new year – and some of the tools they're using to tackle
those challenges.
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, boss information officer at Hilo Medical
Center, a Hawaii hospital that has achieved the best HIMSS Stage 7 ranking for
its IT work, says cyber security will be a best challenge hospitals must face
in 2018 with regards to their EHRs.
"As EHRs mature and gather vast amounts of data,
guarding this data as adept cyber security threats increase must remain at the
forefront," said Wilson. "Educating staff on the best possible use of
hospital systems and placing safeguards within your EHR to constrain the amount
of data accessible is a decent start to beating this challenge."
To staff, having only constrained access to Internet
destinations and applications may appear to be prohibitive, yet CIOs should see
this measure as necessary, she added.
Another major challenge facing EHRs in 2018 is the continued
concentrate on interoperability. Systems should have the capacity to talk with
one another to effectively gain the total photo of a patient as conceivable.
Yet, as hospital and health system CIOs have found throughout the years, that's
a tall request. Innovation and strategies exist to help tackle this challenge,
be that as it may.
"The major challenge that all of us face is theadvancement of interoperability," said David Ratto, MD, a pulmonary and
critical care specialist and hospitalist at Methodist Hospital of Southern
California who has been specifically required with the hospital's EHR.
"Whether we are attempting to accomplish meaningful use or enhance the
overall care of our patients, we require enhanced functional interoperability.
Data must be available and should be seamlessly transferred starting with one
source then onto the next."
How to take on the challenge of interoperability? Ratto said
he'd jump at the chance to see a scale-back on Stage 3 meaningful use – aside
from the interoperability portion.
"That ought not be pushed out to later dates, and in
fact it ought to be mandated that all vendor products meet interoperability
standards," he said. "A portion of the standards unquestionably ought
to be made more straightforward."
On the interoperability front, Mustafa Ozkaynak, assistant
professor in the college of nursing at the University of Colorado Anschutz
Medical Campus, indicated the requirement for hospital and health system EHRs
to play decent with information systems from other kinds of care provider
locations.
"EHR systems ought to be available to accept data fromoutside resources, for example, daily living settings and nursing homes,"
Ozkaynak said. "As more health-related activities take place in daily
living settings – home, work, restaurants, and so on – EHRs ought to have the
capacity to use the data gathered in daily living settings."
To defeat this challenge, hospital and health system CIOs
and other executives ought to create strategies for how data from nursing
homes, for example, can be integrated into their EHRs, he said.
"The starting point ought to survey current
interoperability strategies and reexamine them to be more comprehensive with
the goal that nursing home data can be used by hospitals," he added.
On another front, there is the ascent of value-based care in
the healthcare business. And this change in healthcare repayment from volume to
value will have an impact on EHRs.
"Most EHRs continue to be unwieldy with features headed
toward repayment for which they were produced, rather than toward value-based
care, and that concentration is moving," said Kurt Hegmann, MD, executive
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 place themselves in
the physician's shoes; spend a day following physicians and perceive how they
function with their EHR devices, understand the pain focuses, and hear their
suggestions on enhancing value-based care."
Looking forward a bit, Michelle C. Lardner, RN, appointee
CIO, clinical informatics, in the department of clinical research informatics
at the National Institutes of Health, said genomics functionality in the EHR
isn't necessarily a major challenge at most hospitals going into 2018;
notwithstanding, as this practice develops, the need will show itself
"For those organizations that offer precision pharmaceutical,
the need is certainly there," Lardner said. "That is the challenge.
Data, for example, family history and hereditary test outcomes move toward
becoming information and learning that can tailor patient treatment and could
enhance results."
This data must be readily accessible by the medical
attendants, specialists, geneticists and researchers that practice in this
field. "We championed this necessity and partnered with our vendor to
build up the integrated devices we requirement for our clinicians and
researchers," she added.
And finally, there is the age-old issue of information
overload and clinician burnout with EHRs. Innovation teams need to get it
together on this challenge to enable clinicians to carry out their occupations
without tedious and monotonous technical work.
"EHRs are great for gathering information into one
device, however the work processes to manage this are some of the time
confusing and overpowering for the staff, causing burnout," said Matthew
Ernst, executive of training, documentation and support for digital innovation
and consumer involvement with Thomas Jefferson University. "At the point
when staff get overpowered and start to feel burnout, their profitability goes
down and conceivable patient safety issues can sneak in."
One of the ways to beat this challenge is to support a team
that is dedicated to working with the staff to enable them to understand the
work processes, work out easy routes, and report back to the EHR analysts on
any issues – call this the EHR consumer encounter team, Ernst recommended.
"This team would partner with the staff, super-users,
and designated department contacts, and would give the staff a feeling of
possession into its use," he explained. "The goal would be for the
staff to wind up plainly more proficient in its use and be liberated for
additional tasks."
Income recuperation can be a logical outgrowth of this
approach, he added. Executives can set up a couple of measurements to measure
this.
"One could be the quantity of patients a specialist
finds in a day," he explained. "For example, a specialist turns out
to be more proficient in reporting in the EHR and can see an additional patient
a day, three days seven days. For a hospital with 500 physicians – 1,500 patients
seven days – 78,000 patients a year. There would be other income openings with
these patients."
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