The Electronic Health Record Association explains the benefits of digital healthcare for both patients and healthcare providers.
Considering how accustomed we are to sharing, storing, and creating data via digital devices, it is perhaps surprising that our healthcare systems are not taking full advantage of the opportunities modern technology presents when it comes to storing patient data. Not only could the process of recording patients’ information electronically be safer and more accurate, it could also help to streamline workflows, thereby enabling patients to be seen more quickly and healthcare providers to work more effectively across different areas of care.
Improving the quality and efficiency of patient care, by encouraging wider use and improved interoperability of health information technology, is the main focus of the Electronic Health Record Association (EHRA). Operating within the US, the EHRA works collaboratively with other organisations and stakeholders to expand the benefits of electronic health records (EHRs) and health information technology. Lorna Malkin, Junior Editor of HEQ, speaks to Hans Buitendijk, Chair of the EHRA’s Executive Committee, about the benefits of using EHRs within different healthcare settings.
What is the role of the EHRA within the digital healthcare sector? What are your key goals as an organisation?
We are an organisation of EHR vendors focused predominantly on promoting the use of EHRs and health IT in the US. The EHRA was formed in 2004 as a result of the growing interest in the use of electronic health records (EHRs). In the same year, the Office of the National Co-ordinator for Health Information Technology (ONC) was formed through an Executive Order and a new national framework was established to help enhance, improve, and promote the use of health IT at a federal level, across the states. As this progressed, and the most effective interoperability and functional standards were identified, EHR vendors started to come together and look at how organisations can advance health IT on both an independent level and by working collaboratively with other EHR stakeholders.
Today, we have around 30 organisations on board covering 80% to 90% of inpatient capabilities and a very large percentage in the outpatient space too. The organisations support a range of medical departments including behavioural health, post-acute care, inpatient care, ambulatory care and everything in between. This really creates an extensive area of capabilities.
By adopting a collaborative approach with other EHR vendors, we have built strong working relationships with the industry and with regulators at the federal level such as the ONC and Centers for Medicare and Medicaid Services (CMS). We all have the same goal of trying to move the agenda forwards and improve health IT across the board.
What are the potential benefits of a wider rollout of electronic health records? How can healthcare providers best ensure patients’ data is kept secure?
Firstly, having health IT in general provides a better ability to collect, share and take advantage of the data that is available to us. By doing so, we can improve clinical decision support, and provide a more complete picture of a patient’s health. This can be done through encoded format, as well as textual format to enable analysis and look at research trends. This can also give us a better picture of health trends at the population level.
Additional benefits of this include streamlining workflows, reducing patient turnaround time, and improving the overall quality of care processes – electronic prescription services are a good example. Digital records also ensure the patient data is more accurate, as opposed to referring to handwritten notes that can cause misinterpretations. Likewise, if patients are receiving care from different providers, health IT allows us to share data across organisations more efficiently. To date, it has been difficult for patients wanting to switch healthcare providers for speciality care or otherwise, because doing so requires all a patient’s data to be made available to the next provider.
Previously, organisations were primarily looking at how data could be connected from within. However, with the shift from fee for service to value based care and through legislative and regulatory initiatives by Congress, CMS, and ONC in particular, the focus has shifted from merely meeting requirements that demonstrate the ‘meaningful use’ of EHR technology within provider organizations to improving the quality of care and patient engagement through interoperability across provider organizations. Health information technology (HIT), and EHR in particular, can facilitate a visual record of a patient’s health wherever they are and in turn, encourage providers to improve their interactions in the transit and automation of care.
How could patient data be better aggregated and analysed to inform medical decisions?
There are a couple of ways. One is horizontal aggregation whereby data develops with the patient as they move through the care system. When the patient is discharged to another setting or referred for an opinion, for instance, a certain set of data flows with them, so that the patient record at the receiving end is more complete.
In the context of population health, data can be collated and analysed, provided the population is large enough to warrant that analysis. Data can also be collated at a health information exchange (HIE) level or through registries that focus on certain diseases and conditions. This type of data collection allows us to move collectively and look at trends and therefore improve guidelines for care providers and promote best practices. Additionally, information gathered from both operational and analytical data can be used more immediately, as part of clinical decision support, to promote and progress patient care.
The advent of smart apps is also enabling us to gain a more holistic dataset, therefore that data can be used to identify opportunities for better care and more efficient flows at all points along the healthcare spectrum.
Is patient resistance ever an issue in data collection and sharing? How could this be ameliorated?
There is always some data that people feel is too sensitive or that they just do not want to share. At the same time, there is benefit to having a more comprehensive patient record that is relevant for better understanding a person’s overall health and how that can be improved, as opposed to fragmented records across certain parts of the healthcare systems. Of course, there will be data that systems can collect but patients are not necessarily willing to share. Likewise, patients may be willing to share their data with one healthcare provider but not necessarily with another. If you are in the mental health space, then there might be some data that you are not ready or willing to share across settings, or policies at a jurisdictional level have identified as unsuitable to share more widely. At present, a lot of patient data is collected via handwritten forms and simply offers a choice to ‘opt in’ or ‘opt out’. Electronic systems are not advanced enough yet to fully account for variations in policies and allow patients to manage the specific data that they do and do not want to share.
How could policymakers better support wider technology adoption in healthcare?
Policymakers are keen to identity the most important issues for the community they represent. They are also influenced by the jurisdiction, the levers available, the different tools available and culture of how policymakers and industry work together (and that can vary in the US by state).
On the ONC website you will see the minimum capabilities the EHR should require to be certified, but it is all voluntary. By contrast, on the CMS website, the focus is more on the providers and those that have bought systems; initially, healthcare providers who bought EHR systems were incentivised by bonuses. However, this has now shifted so that if you do not use EHRs you get a penalty, and if you buy them but do not use them, you will get penalised.
There are examples where certain capabilities become a so-called condition of participation in the EHR programme, so there is a little bit of back and forth between capabilities being established to be certified and the leverages and incentives you can have. Policymakers definitely have a role to play, but they can stand back and let the market take control, or they can be involved in helping to accelerate an initiative. In some healthcare settings, you will see a very strong collaboration between the respective stakeholders, policymakers, vendors and industry organisations. Ultimately, the final decision regarding criteria and standards for the use of EHRs lies with the regulators and is based on the legislation that they have available.
What we have learned from working in the US is that if we engage with different stakeholders early on, as soon as a problem is identified, we are much more successful in working together to find solutions and ultimately move the agenda forwards.
Chair, Executive Committee