From complex electronic health record systems to mobile health applications, technological innovation and adoption have proved especially challenging – even downright polarizing – for the health care industry. But this is all changing due to requirements set forth in the federal Health Information Technology (HITECH) Act and the Affordable Care Act. There is also increased pressure to lower the rising cost of health care while improving quality.
Entrepreneurs and technology companies are focusing on providing tech tools that can satisfy regulations, lower costs and improve the effectiveness of both health administrators and health practitioners. But success or failure of these technologies often depends on financial resources, effective leadership, and, perhaps most of all, intent; specifically, whether healthcare providers are using them as a means to enhance the quality of care – not just increase the speed at which it’s delivered.
1. Electronic Health Records
Electronic health records (EHR) represent an on-going effort to streamline care by digitizing patient data. An EHR is a digital version of a patient’s medical record that can be updated in real-time by authorized health professionals. It provides a broad view of a patient’s medical history by allowing medical diagnoses, conditions, treatment plans and test results to be accessed quickly and securely using Web-enabled devices.
In addition to providing instantaneous access to health information, one of the chief benefits of an EHR is that it improves care coordination by allowing patient information to be shared by multiple health care providers and organizations, including specialists, hospitals, pharmacies, emergency facilities, and imaging centers.
The U.S. Department of Health and Human Services (HSS) reports that EHRs improve health care administration by increasing efficiencies and reducing costs. The main source of savings is the automation of time-consuming processes associated with traditional paper-based medical records. Chart transcription, filing and storage are all simplified when information is captured digitally at the point of origin and stored via a cloud-based system. There is also evidence that EHRs reduce medical errors and improve the overall quality of patient care.
EHR adoption is becoming more widespread, but the systems are far from perfect: recent studies have shown pushback among doctors themselves who feel that the technology requires more clerical work, which cuts into their time with patients.
For administrators, EHR-related headaches tend to revolve around budgetary and staffing concerns – both the financial burdens of purchasing EHR software and accumulating the specialized staff necessary to implement and maintain it. Greensboro, N.C.-based Moses Cone Memorial Hospital earned a “negative outlook” from a recent Standard & Poors assessment and lost $17.9 million in the third quarter of their financial year, due in part to staffing and implementation costs incurred as they coordinated their EHR system.
Other healthcare delivery systems have seen more success: representatives from Henry County Health Center in Mount Pleasant, Iowa say that hospital leadership ensured a transparent selection process and provided ample training for those who would utilize the technology. These factors, in turn, engendered more trust and support among staff.
Dartmouth Hitchcock Memorial Medical Center CMIO Andrew Gettinger explained the process of EHR implementation first-hand. Though the shift was ultimately necessary, he noted a few things he would have done differently – such as extending the initial two-week “round-the-clock coverage” period wherein knowledgeable practitioners were on-hand at all times to help doctors use the system. He also warned that EHRs can become less time-efficient for specialists if they don’t include certain special features.
2. Interactive Personal Health Records
Families with compounding health issues – or even just regular primary care appointments – can easily accrue reams of paperwork, from bills and statements to complicated insurance correspondence. Interactive personal health records (PHR) – an extension of the EHR that allows patients to manage many aspects of their own health care – aim to replace this kind of record-keeping and simultaneously make it easier for providers to understand their patients’ needs. The PHR is automatically populated with EHR data from all of a patient’s providers and can be accessed by the patient with a Web browser at any time and from any location. Lab results, immunization records, and appointment dates are all types of information you might find in a PHR. In addition, the interactive interface allows patients to enter information into their records; this data is then forwarded to the patient’s physician.
The key difference between the PHR and EHR is that the former is intended for patient use, presenting data in a format that is designed for those who don’t have a background in health care. The benefits of PHRs include increased patient engagement: research has indicated that patients who use one are almost twice as likely to keep up to date with clinical preventative services. The PHR also provides patient access to personal health information when traveling and during emergencies. Health care administrators benefit when patient information is accessible on an interactive PHR since less time is needed for patient questions and information requests.
Though many patients still express concerns surrounding data security, privacy, and costs, PHRs have proven successful in a variety of communities. Christiana Care Health System in Wilmington, Delaware saw “enhanced patient satisfaction, information control, and access for 250 of its cancer patients by providing them with PHRs housed on CapMedKeys.” Patients – who were also granted free training sessions about PHR use – were ultimately so enamored with the system that they requested more storage for their data entries. They can also be helpful monitoring for patients with chronic conditions, like lupus.
3. Telehealth Technologies
Telehealth is a term used to encompass methods, devices, and technologies that are used to deliver medical education, treatment, and information from a distance. This broad category of technologies covers many applications – new innovations are being developed and tested every day. Video conferencing, for instance, supports real-time interaction via audio and video links, remote patient monitoring, and the transmission of digital images for remote diagnosis.
Although remote care is not a new concept, today’s wireless networks, mobile devices, and advanced data compression schemes are enhancing its ability to treat patients more effectively. It also allows health care professionals to connect with distant resources: primary physicians in remote locations can consult with specialists as they grapple with rare or difficult-to-treat conditions. In-home health care, telehealth technology can be used to supplement the services of a visiting nurse. Telehealth technology can also be used to train health care professionals and provide patient education via webinars and interactive teleconferences.
Successful telehealth technology stands to improve budgets and quality of care: a study that focused on telehealth use in the Veterans Administration found that a combination of remote patient monitoring and electronic care coordination reduced hospital admissions by 19 percent and shortened hospital stays by 25 percent.
Telemedicine presents plenty of financial and logistical hurdles. Ensuring that these systems integrate seamlessly with growing EHR systems (interoperability) is still a major issue, and many patients still prefer to be seen by an in-person provider. For many rural communities and smaller hospitals, however, telemedicine stands to improve care standards dramatically.
For instance, it saved the life of a rural Maryland patient who contracted necrotizing fasciitis (or as the media has popularized it, “flesh-eating” bacteria). The small ICU at Atlantic General Hospital didn’t have a specialist on-hand, so they called in a critical care doctor who was able to diagnose the condition – from 125 miles away. The system relied on “voice, video and high-speed data lines constantly streaming information about vital signs, medications, test results and X-rays” and ultimately expedited the patient’s transfer to a hospital equipped to treat the condition. A study conducted at three California clinics found that the amount of preparatory planning, workflow/scheduling management, and costs comprised significant hurdles – but that patient and provider satisfaction were generally very high.
4. Computerized Physician Order Entry (CPOE)
Computerized physician order entry (CPOE) has been identified by HHS as a core component for improving health care delivery, especially in hospital settings. CPOE allows physicians to enter medical orders and instructions related to patient treatment directly into networked systems. Information is then shared with medical staff and with organizations responsible for fulfilling orders, including laboratories, radiology departments, and pharmacies.
CPOE systems have the potential to reduce errors related to transcription and handwriting, prevent duplicate orders, identify incorrect dosages, and simplify the inventory process. These systems contribute to increased visibility in the patient care continuum and encourage a team approach between physicians and health care delivery organizations. They improved medication turn-around times by a dramatic 58% for Montefiore Medical Center in New York, and “estimated time savings of two hours per day for each ward clerk, 20 minutes per day per nurse, and 200 minutes per day per pharmacist.”
University of Kentucky HealthCare, a private health care system in Kansas, found that successfully managing and paring down order sets was integral to success – and that viewing CPOEs as a rote, clerical task rather than an opportunity to consider the quality of care being delivered was detrimental. In reviewing her experiences with CPOE technology, UK HealthCare CMIO Carol Steltenkamp emphasized that administrators and physicians should not just consider what kind of tests or procedures they’re ordering, but why they’re providing that particular type of care.
Email, text, and instant messages have replaced many forms of handwritten communication. E-prescriptions take handwriting out of the prescription process by allowing physicians and other health practitioners to send prescriptions in electronic form directly to pharmacies from the point of care. The most obvious benefits include a reduction in prescription errors due to problems with handwriting interpretation. A Weill Cornell Medical College study published in 2010 found that prescription errors were reduced from an astonishing 42.5 per 100 paper-based prescriptions to 6.6 per 100 one year after the adoption of e-prescriptions.
E-prescription systems are often integrated with electronic health records, providing decision support by checking a patient’s condition and other prescriptions for possible adverse reactions. These systems can also notify the prescriber about alternative generic medications.
According to HHS, physicians and their staff spend hours each day responding to clarification calls from pharmacies. E-prescriptions can also automate the prescription renewal request and authorization process. So in addition to improving patient safety and quality of care, e-prescriptions can reduce the number of time prescribers and pharmacies spend on the phone – thus increasing the time available for direct patient care and interaction.
Rochester General Health System (RGHS) – a 528-bed tertiary care facility in Rochester, New York – encountered pros and cons as they implemented a full-scale e-prescribing system. Spotty coordination with pharmacists, insufficient internal leadership dedicated specifically to this initiative, and a dearth of the necessary hardware, including tablets, laptops, and electrical outlets. Their experience also yielded, however, an 80 percent decrease in the number of prescription-related phone calls and a 50 percent decrease in patient complaints.
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What are your thoughts?
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Emily Newhook is the outreach coordinator for the MHA degree program from The George Washington University, MHA@GW. Outside of work, she enjoys writing, film studies, and powerlifting. Connect with her on Twitter.