EHR Implementation Rising, But Hurdles for Healthcare Providers Remain

Thanks to government incentives, more healthcare organizations in the United States are implementing Electronic Health Record systems than ever before. But EHR implementation isn't the same as EHR adoption, which requires significant investment in planning, training and personnel.

Recent data from the Centers for Medicare and Medicaid Services point to progress in Electronic Health Record (EHR) implementation. Under the meaningful use program established by the 2009 stimulus bill, 75 percent of eligible hospitals and 73 percent of healthcare providers have received incentive payments for attesting to EHR use, CMS says.

In addition, the number of hospitals using EHR systems with "advanced functionality" has grown from 9 percent to 44 percent between 2008 and 2012, with growth from 17 percent to 40 percent shown for physician offices. (Advanced functionality goes above and beyond the criteria of the meaningful use incentive program and includes features such as viewing imaging test results.)

However, the picture is far from rosy. Separate studies suggest that 23 percent of providers want to switch EHR systems and that, given the choice, 40 percent of providers wouldn't buy the same EHR system again.

Why is so much of healthcare industry dissatisfied with electronic health records? Recent reports from CompTIA and TEKsystems Healthcare Services suggest that it's a delicate mix of a lack of interoperability, complexity, poor training, inadequate IT resources and tenuous relationships with EHR vendors.

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CompTIA's 4th Annual Healthcare IT Insights and Opportunities study, which surveyed 375 doctors, dentists and other EHR users, concludes that only about 60 percent are satisfied with the system they have. In addition, 40 percent characterized EHR implementation as "worse than expected," while 56 percent "acknowledged being less than optimally prepared for the transition to EHR."

Specific issues with EHR systems vary, but CompTIA notes several:

  • Return on investment is poor; the general sentiment is that an EHR system "doesn't improve patient care, nor does it improve practice productivity or efficiency"
  • Sharing information with other healthcare providers, regardless of the EHR system they use, remains a challenge
  • Users have multiple log-ins, which they tend to manage using a scrap of paper, deeming it worth the obvious security risk
  • Standard codes available out of the box are often inadequate for medical specialists, and developing specific codes is "viewed as an inefficient use of their time"
  • Many systems lack an audit trail, so it's difficult to determine when information was added to a patient record and by whom.

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The takeaway, CompTIA concludes, is that "IT solution providers must be extra diligent in communicating the steps of the implementation plan, especially in the pre-implementation stage…For many healthcare providers a transition to EMR/EHR entails not only a physical change in workflow, but also a change in mindset."

EHR User Training Shouldn't Be Overlooked

TEKsystems, which released its research at the HIMSS13 conference in March, finds that EHR implementation is one thing, but EHR adoption—getting physicians and clinicians to effectively and efficiently use the system—is another.

Von Baker, practice director for healthcare services at TEKsystems, says healthcare organizations need to realize that the change management and "clinical transformation" that accompanies EHR use must be part of the project lifecycle from the planning stages. Business processes are going to change, she says, and EHR users need to know how this will change what they do today compared to what they will do tomorrow.

Bringing users into the process at the outset has significant training advantages as well, Baker says. The sooner that workflows and business processes are incorporated into training, and into memos or announcements about what the EHR system will look like, the sooner that information is disseminated to end users, she says. This also makes it more likely that practical scenarios, such as different use cases for orthopedics versus pediatrics, make their way into curriculum development.

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When this happens, organizations can avoid the "why" questions that so often dominate classroom-style EHR training sessions and instead focus on exercises that engage clinicians in how EHR technology is used, Baker says. It also allows for assessment, an often-overlooked aspect of training that helps users gauge what they know and trainers understand what they need to work on, she adds.

Relationship Among EHR Vendors, Users Evolving

Many EHR vendors offer templates for lesson plans. Others conduct onsite training sessions. These can be a good start, says Allen Kriete, vice president of healthcare services for TEKsystems, but organizations need a plan for when the vendor leaves.

In addition to assessing clinical workflow and IT architecture, this needs to involve a holistic look at competency gaps from both a technical and functional perspective, Kriete says. Doing so will put EHR training and curriculum in the context of change management, ROI and efficiency gains—all of which will have a long-term impact on clinicians and, it is hoped, let them focus less on technology and more on patient care.

This doesn't mean healthcare organizations should establish a "set it and forget it" relationship with their EHR vendors. Far from it. As CompTIA found, providers need numerous things from their vendors: Deployment and training help, regular system updates, remote system monitoring and a "consistent point of contact…familiar with the healthcare provider's needs."

This amounts to a "managed IT services relationship," CompTIA says. It's not something that EHR vendors should pitch right away, though, as "Few healthcare providers at small or group practices are familiar with the concept of managed services."

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Even if such a relationship is established, though, healthcare organizations will need to add staff as EHR adoption expands. CompTIA notes that many healthcare workers handle EHR maintenance and troubleshooting themselves, as they manage credentials, install patches, back up data and manage system preferences.

On a small scale, this makes economic sense, CompTIA concludes; eventually, though, "time a physician spends IT troubleshooting an IT issue is time away from seeing patients."

Brian Eastwood is a senior editor for CIO.com. You can reach him on Twitter @Brian_Eastwood or via email. Follow everything from CIO.com on Twitter @CIOonline, Facebook, Google + and LinkedIn.

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