Technology has made an impact on all spheres of society and business, including the healthcare sector. Today, most healthcare organisations are starting to see the benefits of data management and analytics. In fact, according to research, the majority of healthcare organisations are considering the use of Electronic Medical Records (EMRs), not only to improve operational patient management, but also to improve the information and insights delivered to the business, and to enable analytics.
An electronic medical record (EMR) or electronic health record (EHR) refers to the systematized collection of electronically-stored patient health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EMRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.
Recently while undertaking some research on this topic, I came across an article that indicated that in 2008 only two states in the US had EMR adoption rates of over 20%. However, today the picture is drastically different and according to the latest statistics from the Office of the National Coordinator, electronic health records are now used in more than three-quarters of the healthcare organisations across the United States. This trend appears to be happening world-wide too.
One of the reasons is because healthcare organisations are finally seeing the true value of data and analytics and are opening to implementing new systems into their business practice to enable more mature data management, and through that, more and better analytics and informed decision-making.
EMRs can offer a number of benefits to a healthcare organisation. First and foremost it guides the management and other healthcare providers around what data needs to be captured, reported and analysed. But, from a less technical perspective, this data can inform staff and decision-makers on aspects like the direct and indirect costs of surgery, the efficiency and quality of the processes that are involved, and the benefits obtained by paying attention to these – all which is incredibly beneficial to the levels of service the organisation can deliver.
The data contained in the EMR forms the blueprint of the data required to run and manage a hospital effectively. The EMR contains data about each patient, their interactions, their episodes, diagnoses, treatments and much more. Various insights can be obtained by analysing the EMR data, from clinician performance, to ward and bed utilisation through to scheduling and treatment effectiveness.
EMR data can further be used to analyse patient characteristics, behaviour, and long term reactions to diagnoses and treatments. The EMR data is crucial to predict the likelihood for readmission. Medication adherence can also be analysed and forecasted. EMR data can also be used to analyse ward and bed occupation, theatre utilisation, staff scheduling and effectiveness, as well as clinician performance, in order to improve performance and effectiveness. An extensive EMR further “feeds” a hoard of measures on diagnosis, treatment, coding, funding, pathology and laboratory results, even pharmacy and drug availability and distribution, as well as measures on medication availability and dispensation.
Challenges
However, the technical staff at many hospitals complain that the EMR is a “black box”. The underlying database structures are complex and obscure, and in many cases are not well or openly documented. It seems the EMR vendors don’t want you scratching in there to get access to the data. But, in reality, you need to extract the data in order to transform it to a form useable for business intelligence and analytics. That is when the investment in the EMR really pays off – if it can provide information that enables better decision-making, management and as a result, better patient outcomes. This problem is quite ironic, as the EMR’s contents are actually the hospital’s data – hospital staff should have access to their data when and where they need it. EMR vendors really should provide open and efficient interfaces to the underlying data to enable proper business intelligence and analytics.
Adopting the applications that manage the EMR data is a huge undertaking, as it affects large parts of the organisation, and therefore it usually requires a lot of delicate change management. For many providers and their clinical teams, effective implementation of an EMR requires a change in “how we’ve always done things.” Like any change, it might not be immediately welcomed. However, in order for any “downstream” analytic tools to be effective, it is essential to use the EMR as it was designed. “Bending” the way that the EMR functions will limit the efficacy of any downstream business intelligence program or analytics platform.
As with implementing all new processes, hospitals can encounter some challenges along the way, like when nurses become so busy they don’t always have time to enter the data or time or “screen space” to enter the full picture, which means that the EMR does not contain the right information. Obviously with the right training and support this can be overcome, and together with the necessary change management, it has to be done.
Of course today we still encounter the fact that a few hospitals are still cautious of EMRs and prefer the ‘old’, more familiar ways of running their hospital – manual clipboard and paper recording, and after-the-fact coding and electronic capturing. “Old school” workers in these organisations worry that “the system” may get it wrong and doomsay about the impact this can have. However, to my mind the pros far outweigh the cons – but the essence is to ensure the implementation and take-on is done correctly.
Fit for purpose?
Of course not all EMR implementations are well received. A recent Black Book Poll found that one-fifth of Hospital EMRs are poor fits (#HealthIT 6 Apr 2015). This is a really concerning statistic. However, defining what constitutes a “poor” fit is really hard when you realize that a poor fit has to be defined in terms of hundreds and possibly thousands of EMR users in a hospital. In fact, it’s really hard to make broad statements about EMR satisfaction at a hospital. The doctors may hate it, but the executives love it. The front desk may be annoyed by it, but the pharmacy is really happy. The nurses may love it… ok… I don’t think I know of any EMR that’s loved by nurses. Nurses often get left out in the EMR design and we’ll have to leave it at that for now – that is an interesting discussion for another blog post
Is switching EMRs an option?
But, let’s think about what it means that 20% of hospital EMRs are a poor fit. Does that mean that we’re going to see a wave of EMR switching in the hospital world? I don’t think so. The reason I don’t think so is that implementing a hospital EMR is too expensive. Plus, changing an EMR is so disruptive that you have to be really down on your EMR to actually switch. Sure, some organisations are that down on their EMR that they’ll switch. However, most of them don’t like it, but they aren’t ready to go through heart replacement surgery and take out their current EMR and replace it with a new one.
Some other factors at play is that they may not like their current EMR, but it’s the devil they know. That’s a powerful reason not to switch. Also, is there really a better alternative? Many who aren’t satisfied with their EMR aren’t convinced that switching to another EMR will be much better. Plus, many of these organizations are in the middle of meaningful use. If you switch EMR vendors in the middle of meaningful use, you might as well announce that you’ll be taking a year off from meaningful use (and all that entails).
While I don’t think we’ll see a wave of immediate EMR switching, once the renewal licenses come up, we may see more switching of EMR. Plus, if someone can come out with a high quality cloud based EMR for hospitals, with an efficient take-on mechanism, then that could help with switching costs and effort as well. However, until then, hospitals have mostly chosen their horse and now they have to ride it out. Of course, this assumes they don’t get acquired by a larger hospital system and are forced to switch EMR. Some of that is currently happening and is likely to continue.
Concluding remarks
Given the advances that technology can bring to patient service and hospital efficiency, I am confident that the healthcare industry, while still going through its own changes, will carry on to embrace EMR and analytics technology on a wider basis – and then enjoy the ability it has to make a positive impact on data management and decision-making.
It’s necessary to do more research into EMR and analytics technologies, and read about the benefits it can offer an organisation. As I truly believe, if implemented correctly, EMR and analytics applied to the EMR’s contents will make a positive impact on both patient outcomes and the healthcare industry as a whole.
