First developed in the early 1970s as clinical data repositories, major developments in the early part of the 21st century propelled the evolution of EMR systems to keep pace with ever-expanding industry requirements. Though these systems offer many benefits, their considerable operating and financial costs have created blind spots that healthcare providers can’t afford to ignore.
The benefits of Electronic Health Record and Electronic Medical Record systems (we’re using the terms interchangeably) are well documented. For providers, these increasingly sophisticated systems perform a long list of functions, all designed to improve care and productivity. Healthcare systems and hospitals spend millions, sometimes billions of dollars implementing and operating their EMR systems.
As a result, providers often grant their EMR companies a de facto first-right-of-refusal, even when deficiencies have been detected in their ability to deliver in key patient satisfaction areas such as financial engagement where there is a persistent gap between what patients want from their healthcare providers and what they actually end up getting.
According to HealthIT.gov, a resource of The Office of the National Coordinator for Health (ONC), the advantages of electronic health records are many. To name a few, EHRs:
- Provide accurate, up-to-date, and complete information about patients at the point of care
- Enable quick access to patient records for more coordinated, efficient care
- Make it possible to securely share electronic information with patients and other clinicians
- Help providers with more effective diagnoses, reduce medical errors and provider safer medical care
- Enable safer, more reliable prescribing
- Reduce costs through decreased paperwork, improved safety, reduced duplication of testing and improved health
The federal government’s interest in these care-related advantages led to the creation of the ONC in 2004 under the U.S. Department of Health and Human Services (HHS), which also oversees The Centers for Medicare and Medicaid Services (CMS). Shortly after, EHRs were incorporated into the Health Information Technology for Economic and Clinical Health Act (HITECH), which provided higher payments to healthcare providers that meet meaningful use criteria, which involve using EHRs for relevant purposes and meeting certain technological requirements.
Clearly, the interests of the healthcare industry, healthcare consumers and the U.S. government all align with respect to electronic medical and health systems. That’s why more than 95% of all hospitals in America are using such a system.
How the High Cost of EMR Implementations Creates Blind Spots
The cost of many large-scale EHR implementations exceeds a billion dollars. But these expenses, considerable as they are, do not represent the entire picture. Other costs that may be less measurable but are real nonetheless are cultural and operational. EMR systems reach deep into the operating structure and day-to-day workflow of nearly every stakeholder in a hospital’s or health system’s ecosystem. Managing this complex process places extraordinary demands on everyone in the organization, most particularly the leaders, technicians and managers who are tasked with getting it done.
This article, authored by Gregg S. Meyer, MD of Partners Healthcare; O’Neill Britton, MD from Massachusetts General Hospital and Daniel Gross, MBA from the Dana Farber Cancer Institute and published in the New England Journal of Medicine elaborates on the challenges associated with EHR implementation and ways to overcome them. A partial list of the challenges includes: cultural issues, focus issues (technical or clinical?, front line or administrative?), scale management, interoperability (the system’s ability to “talk” to other systems) and fatigue.
To address these challenges, the authors suggest specific strategies to tackle each of the challenges. Noteworthy among them from our perspective is this: What the patients want is primary. “…Always start with how the decision will impact patients and what they will want. Providers and administrators are important, but their needs should come secondary to patients”.
In our experiences working with health systems and EMR companies, “what patients want” is the area where blind spots are most likely to exist. It’s easy to understand why. Hospitals invest thousands of hours and millions of dollars to find, configure, implement and operate their EMR systems. In the process, management, the front line and clinicians are all required to learn and use the new system. The entire process is costly and difficult. It’s also exhausting.
As a consequence, when it’s determined that there are still gaps in the providers ability to deliver “what patients want”, they often lack the will to do it. Thinking instead that their new Swiss Army Knife EMR will solve the problem eventually, they delay action and continue falling short of their patients’ expectations.
Enhancing EMRs to Bridge the Gap Between what Patients Want and What They Get
Great as EMR systems like Epic and Cerner are, the ways healthcare provides use their systems can run counter to their intentions. In this excellent article from Atul Gawande, CEO of Haven, Dr. Gawande points out that digitization has added to physician workload, exacerbating burnout and reducing the amount of time physicians spend with their patients. Yet, in The Beryl Institute’s Consumer Study on Patient Experience, 2,000 healthcare consumer respondents offered that being listened to, communicated to in a way they can understand and treated with dignity and respect are the three most important factors influencing their experiences. It would seem, therefore, that the way EMRs are deployed today is having a deleterious effect on both physician and patient experiences.
Patients are not happy with their financial experiences either. According to this Advisory Board survey of 1,000 patients published late last year, the vast majority said they loved getting a pre-service bill as a growing number report anxiety around the cost of care, stating that knowing in advance what they’ll owe makes it possible for them to pay. This not only improves their experiences, it also improves the probability of payment. Respondents also said they wanted access to a financial counselor early in the care experience before treatment, allowing them to execute key interactions like payment options and point-of-service payments.
Given the choice of either: 1) price transparency in the form of a preservice bill; or 2) a consolidated bill, patients who are less worried about their out-of-pocket expenses ranked consolidated bills as their number one or two preference. Most consumers are confused and frustrated by the number and source of bills they receive from their healthcare providers. They want a single presentation of all their bills that is easy to understand and easy to act on. Again, this not only makes for better patient experiences, it improves and accelerates the probability of payment.
Loyale Healthcare, bridges this gap. Working with healthcare companies that use leading EMR systems such as Epic, Cerner, Meditech, Medhost, Athena, Allscripts, eClinical Works, SIS and others we are integrating patients’ financial experiences with the rest of their care episode. Recognizing that patients don’t perceive two separate experiences, one medical and the other financial, our solution enables a single, seamless patient experience from beginning to end. That’s what patients want.