Posts Tagged: EHR

New Study: EHR Systems with Clinical Decision Support Tools Reduce Healthcare Costs

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ehr systems

Every healthcare organization has similar objectives for data management. They want information to be accurate, accessible, portable, and interoperable. They’d also like to save money whenever possible. A new study on EHR systems and clinical support tools reveals they can. 

However, integrating EHR systems and clinical support tools isn’t always easy. In this post, we’ll look at the study and its findings. Then discuss the challenges with data exchange between systems.

About the Study

The study, published in the U.S. National Library of Medicine, sought to understand the economic impact of clinical decision support (CDS) systems and EHRs. Researchers from the Mount Sinai School of Medicine (New York) and the University of Potsdam (Germany) analyzed 27 studies involving EHRs and CDS interventions. 

After evaluation, the teams found 22 of the 27 reports showed a positive economic impact after CDS tool implementation. There were several categories of cost reduction:

  • Unnecessary lab work
  • Duplicate order entry
  • Reducing antibiotic prescriptions

While cutting expenses in these three categories is a win for healthcare organizations, the study’s not all good news. It supplements its findings with context around “malfunctions” that could arise and increase costs. Additionally, the researchers note that CDS tools have high up-front costs and maintenance fees. 

If You Want to Save, Integration and Interoperability Are Necessary

In looking at the cons of integrating the two systems, the study focuses on the two challenges above and their potential to offset any financial gains.

ehr systems CDS tools

Malfunctions

Integrations don’t always run smoothly, especially in healthcare. The APIs can be complex and must also follow any compliance guidelines. Sometimes a true integration isn’t even possible between disparate systems, so instead, interoperability is the workaround. 

Of course, interoperability in healthcare is not perfect either. Data exchange between EHR systems and CDS tools could include several hiccups. One of the most serious but solvable is IT teams that lack bandwidth. For instance, if your healthcare system purchases a CDS tool and wants to use it in conjunction with an EHR, your IT team must work out the connection—integration or interoperability. It’s no secret that healthcare IT teams are running lean and dealing with many issues, only exasperated by COVID-19. 

What’s the solution? Outsource the integration or data sharing to a provider that can deliver quickly, accurately, and compliantly. 

Initial Costs and Maintenance Fees

With any health information system (HIS) procurement, there will be substantial upfront costs. To justify it, you need to understand its value. How can adding this HIS to your EHR system eventually save money and improve care? 

With the right CDS tool, you can know, based on research, you can reduce costs in the areas defined above. Reducing these incidents can also lead to better health outcomes for patients, saving money for the entire healthcare ecosystem. 

When evaluating tools, seek out those that will work with your EHR and has all the features you’d expect in a CDS. Do a trial run with a few platforms before making a final decision to ensure your investment will pay dividends.

EHR Systems and CDS Tools Should Work Together

Improving your EHR system is a high priority for most healthcare organizations. Augmenting it with other tools is a smart initiative to reduce costs and enhance care. While pairing EHR systems with CDS tools delivers benefits, consider how they will best work together and the sizable initial investment you’ll need to make.

Have questions about data sharing between your EHR and CDS? Explore our data sharing capabilities today!

Why So Much Paper? The Healthcare Digitalization Gap

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healthcare digitization

Paper is a problem if it still plays a big role in your organization. Whether it’s paper files, patients completing paper forms, or paper prescriptions—paper causes inefficiency and heightens risk. While efforts for digitizing patient records, files, and prescriptions have been in place for some time, the healthcare digitization gap still exists.

But why? And how are paper processes costing money and time while also impacting public health data and patient care?

Digital Adoption in Healthcare Wide but Not Without Challenges

The long road toward being technology-centric in healthcare began decades ago. The first EHR appeared in the 1960s, with the Mayo Clinic as an early adopter. Since then, the EHR has been in a constant state of evolution. Yet these early EHRs did not eliminate paper. 

Then the government began to push EHR adoption with a mandate and support for industry-wide adoption in the American Recovery and Reinvestment Act (ARRA). Currently, the adoption rate of certified EHRs in large hospitals is 99%. It was slightly lower for medium, small, and rural hospitals. 

Great—so problem solved, right? EHRs should remove paper from most processes, but it’s not magic. Paper is still prevalent (and so is faxing with 75% of all medical communications still occurring in this channel). The reliance on the fax is another story and illustrates interoperability challenges.

So, what are the real issues with healthcare digitization?

The Patient Experience—Fill This Out

When patients enter a healthcare facility, they are almost always met with a clipboard and forms to complete. They must painstakingly write out all their information and health history. This is not something that happens for only new patients—returning ones get the same drill.

The reality is that patient medical history and records are already in digital format. Your organization already has them—this is especially true if a patient sees multiple clinicians within the same health system.

If a patient sees a primary care doctor one month then a specialist the next, why do they have to fill out the same forms again? If your patient has n

In a health system, it’s likely everyone is using the same EHR. So why isn’t this information visible to all? Or in the case of different EHRs, why is data exchange so hard?  

The solution points back to interoperability and accessibility. What good is an EHR if it doesn’t remove paper?

Paper Prescriptions—Adding Another Layer to the Pile

Most providers use eScripts. Data from 2017 found that 77% of prescribers use eScripts—up from 73% in 2016. That’s progress, but paper prescriptions are still present. 

What makes it even more concerning is there use during COVID-19. A patient receives a paper prescription then must submit that to the pharmacy. The patient must then wait or return later to pick up the medication. It’s inefficient and leads to possible exposure. 

If this seems like a bad idea, you’re not wrong.

Paper Records, Files, and Prescriptions Equal Risk

Many risks come with still depending on paper processes, including:

Higher data breach risk and the threat of HIPAA noncompliance: 

If your organization has PHI on paper, it’s easier for it to be stolen or misplaced. This scenario can be a catalyst for a breach or noncompliance. A survey from the Ponemon Institute and Shred-It revealed that 70% of healthcare organization managers saw or picked up documents containing sensitive information from the printer. 

While we typically consider data breaches to be cyber-related, it can happen with physical paper as well. According to the HHS (U.S. Department of Health and Human Services), 22% of breaches in 2018 were paper-related. 

Why expose your organization to more risk? It may not be viable to remove paper completely from the equation. Still, the less there is, the chance of breaches and noncompliance lessens. 

Human error

If patients are completing paper forms, it’s likely errors will occur. Transposing numbers or misspellings will happen. If the handwriting is illegible, the chance of human error increases. If patients have a single source of truth where they can update their contact information, medications, providers, and insurance information, it’s more efficient and accurate.

Patient experience

healthcare digitization patient experience

It’s frustrating for any patient to have to continue to fill out the same forms over and over again. Providers need to think of patients more as consumers because they have a choice. If providers can improve the experience, they earn loyalty. 

No one likes unnecessary paperwork. It becomes a barrier to the patient-provider relationship. It sends the message to patients that you don’t know their medical history or why they are there. 

The new interoperability rule is attempting to put the patient experience front and center. It’s possible that its eventual deployment will give patients the power to manage their information and ensure it’s portable. 

Is Healthcare Digitization a Priority for You?

In any organization, you focus on what’s a priority. Some aspects of digitization are more urgent because they intertwine with regulations. While paper processes aren’t noncompliant, they are a drain on resources. That means they should probably be a priority—plus, they could help you with patient retention.  

What ways can you eliminate paper from your processes? We’d love to hear your thoughts on the subject!

New Research Offers Key Insights on Health IT Diagnostic Delays

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health IT diagnostic delays

Health IT diagnostic delays are a problem. They stand as a real and urgent threat to patient care. The aim of healthcare IT is to reduce delays through a variety of tasks. They seek to track test results, enable information access, encourage communication between clinicians, and support test selection.

Those are the goals. Achieving them isn’t so easy. To determine the root causes of failures, a new JAMA published research report looked at data from the Department of Veteran Affairs from 2013 to 2018.

Researchers choose this data set to identify the root cause of outpatient diagnostic delays. In determining these, specific IT interventions can be put in place to minimize delays.

About the Study

Knowledge of system interactions is necessary to analyze the delays. These interactions include health IT, users, workflows, and policies. To get to this level of analysis, the authors used the Health IT Safety framework. This framework includes concepts for measuring, monitoring, and improving HIT safety. It has three interrelated domains: safe health IT, safe use of health IT, and using health IT to improve safety.

Further, researchers applied the framework’s aggregated root cause analyses (RCA) to identify and understand safety concerns in the data.

The Results

The research categorized 214 RCAs. Most safety concerns belong to the safe use of healthcare IT (82.6%).

The other domains had little correlation—only 14.5% dealt with safe healthcare IT and .3% attributable to using healthcare IT to improve safety.

The Five Most Common Health IT Diagnostic Delays

Looking further into the use of healthcare IT, the authors pinpointed six root causes.

Technical Issues

healthcare diagnostic delays

The biggest technical issues concern failure to generate notifications. In some cases, set-up of alerts never occurred, while in others, a physician changed the settings. No alerts, no follow up.

Second, incorrect radiology codes were the culprit. If the codes are no longer viable, there will be no triggers for notification.

In some situations, the notification disappeared after opening. If it’s no longer there, clinicians were more likely to miss it.

Equipment not working also drove failures. For example, a malfunctioning printer didn’t print test notification letters. Without protocols to check equipment, this can balloon to a huge problem.

Two more concerns exist for this problem. Hidden dependencies impact information flows. The final issue deals with software upgrades. After upgrades, functionality may change. If no one is monitoring this, it increases lags in notifications.

Data Entry Problems

Data entry is an integral part of patient records. It’s also prone to human error. If information is missing, order entries may not transmit. Compromise of order entries can also occur because prioritization fields aren’t available or outdated test lists.

Missing documents is also a data entry problem. Either clinic notes were missing altogether or, due to user interface issues, were not in the right place.

EHR Inbox Notifications

Primary care practitioners (PCPs) receive these when test results are available. However, the notifications can be excessive, leading to missing important information. According to an information overload study and a practitioner’s views on test results in EHRs, one-third of PCPs miss abnormal test results.

Clinicians could receive up to 100 notifications a day! In addition to notification fatigue, failures happened when there was no coverage for a physician not in the office.

An additional concern is that new users don’t know how to process these notifications due to little or inadequate training. Finally, notifications suffer from ambiguous follow-up roles. In many cases, more than one clinician has involvement in the testing process. However, without a clear protocol on follow-up, many times, nothing happens.

Delayed Communication or Miscommunication

Clinicians use EHRs to communicate time-sensitive and critical patient information. This channel doesn’t always work. This problem usually occurs in how systems use the notes section. Not having consistent communication causes delays.

Miscommunication arises when clinicians use the wrong tools. For example, patient triage symptoms should appear in the triage tool, not a scheduling tool.

Gathering Diagnostic Information

diagnostic delays EHR

Gathering information is a root cause, mostly due to healthcare interoperability challenges. Attribution of the delays in the specific study involved internal and external data sources. Being able to aggregate from multiple sources was met with significant challenges.

The authors found that relevant information was often not visible because it was in pages of scanned documents. The information belonged in a problem list.

The third problem in this category relates to patients seen without a review of abnormal test results. Without it, no one addressed the tests.

These breakdowns occur because of poor EHR UX, as well as issues with workflow and communication.

Not Tracking Test Results

If the system doesn’t track test results, there will be a host of problems. In the study, there were instances of no tracking and broken tracking. Tracking is necessary for patient safety and timely response to abnormal tests. There’s no time for delay in tests that show cancer, infections, or other aggressive diseases.

Why Do the Failures in these Areas?

The authors deduced that these delay causals were people, workflows and communication, and poor UX for users in the system. Users often have minimal training on EHRs, a constant struggle and key reason for EHR dissatisfaction.

How Can Healthcare IT Intervene?

The authors recommend five interventions to address health IT diagnostic delays.

  • Redesign the EHR inbox and message workflow: Restructure the inbox for better prioritization, display, and filtering.
  • Develop safety nets to catch missed test results: Technological tools help ensure nothing goes without a response. These safety nets may already exist in some EHRs, or a custom data plug-in may work. Power the plug-in with algorithms to hunt for unanswered results.
  • Improve diagnostic information visibility: EHRs should take this under advisement. Interfaces should make this information prominent instead of hidden.
  • Track referrals: Healthcare organizations need tracking systems for all electronic referrals so that patients don’t fall through the cracks.
  • Optimize order entry design: To achieve this, EHRs should provide decision support and auto-population with required data. This reduces the reliance on manual entry.
  • Accelerate interoperability: When systems can’t exchange data, limitations, and delays will continue. The new interoperability rule seeks to provide this; however, interoperability is not a smooth journey.

Healthcare Data Management Solutions

If these challenges sound familiar, then it’s time to work on how to minimize these delays. Streamlining workflows, adding new functionality, and pursuing interoperability will be imperative. Your IT team may not have the bandwidth to manage all these needs.

We can help. We offer a variety of data sharing and interoperability solutions for healthcare. Explore how we can become a support system for healthcare IT today.