Optimizing electronic healthcare records

EHR optimization paves the way for unleashing new value in clinical documentation and other processes by enabling better physician experiences and, in turn, patient experiences.

The global healthcare information systems market is expected to reach USD 158.89 billion by 2025 with the CAGR of 7.55 percent during 2020–2025, estimates Brand Essence Research. Increasing adoption of technologically advanced infrastructure in hospitals, diagnostic centers, clinical laboratories, and other medical facilities is one of the key factors expected to boost the market. Digital wearable devices are one such technology that supports real-time patient monitoring. These devices have been witnessing a rise in adoption and demand by patients in recent years. In addition, growing awareness regarding e-prescriptions among practitioners and patients is impacting market growth positively.

Benefits of installing these solutions in various medical facilities include reducing inventory management costs and decreasing incidences of medication errors. A rising number of medical facilities are shifting from paper-based methods of keeping track of data to computer-based solutions, which is not only more effective but faster as well. This is particularly true for large databases.

The increase in the number of initiatives undertaken by various medical facilities is a crucial factor anticipated to boost this market in coming years. Cyber security in the medical field, mobile apps, biomedical informatics, tele medication, virtual reality (VR), artificial reality (AR) technologies, and electronic health records (EHR) are some of the key applications that adopt healthcare information systems.

In India particularly, EHRs have paved the way for healthcare to leap into the digital era. The first wave of EHRs (or EHR 1.0) transformed clinical documentation and the medical profession by enabling physicians with access to a digital version of a patient’s record. As physicians became more acclimated to EHRs, little was done to offset any mounting frustrations with the technology. In addition, emerging challenges driven by the industry’s need to adapt to the new digital era, and shifting stakeholder and organizational demands, added to existing challenges.

Market scenario
The global EHR market is expected to cross USD 38 billion by 2025, according to Global Market Insights. Increasing government expenditure and funding for the development of healthcare IT solutions for better understanding of diagnosis and treatment pattern will contribute to considerable EHR market growth over the projected timeframe. Additionally, rising internet penetration and campaigns conducted to increase awareness about the importance and benefit of EHR among the doctor community will significantly expand the business size. Thus, growing awareness of EHR in hospitals and healthcare settings will accelerate the demand for EHR systems over the forthcoming years.

Increasing implementation of EHR will foster the global electronic health records industry growth in the upcoming period. Electronic healthcare records are used for systematic collection of the patient’s health records in a digital format for better understanding of diagnosis and clinical treatment procedure. Rising adoption of electronic healthcare record for streamlining workflow and enhancing patient care delivery will positively impact adoption of electronic medical records in the forthcoming years.

However, the dearth of capable professionals to handle advanced technology and high cost of EHR systems may hamper the market growth over the upcoming years.
On-premise EHR software market held more than 49 percent revenue share in 2019. Simultaneous access to multiple users and automation of elimination of redundant processes, coupled with better safety of patient information, are the major factors attributable to the segmental growth. Rising advancements in EHR technology such as increased work efficiency in controlled medical vocabulary and clinical decision-support system should drive the consumer preference for on-premise EHR.
E-prescription application market is estimated to witness considerable growth at a CAGR of 6.3 percent. E-prescription offers alternatives to the pharmacists to choose among various generic drugs as well as potentially allergic reactions. This feature enables safe and reliable documentation, with less errors owing to illegible writing style of the prescribers. Additionally, flexibility of management of broad range of data points in drug store management will offer attractive growth opportunity for e-prescription market in the future years.

The Indian EHR market held over 22 percent market share in 2019, and will witness progressive growth over the next 5 years. Wide accessibility of EHR in specialty centers and hospital-attached research centers will spur the market growth over the upcoming years. Several providers of EHR systems in India are focusing on its innovation. Furthermore, growing awareness pertaining to the benefits of EHR will expand India EHR market over the coming years.
Few notable players operating in the EHR market are Allscripts, Cerner, eClinicalWorks, GE Healthcare, and Epic Systems among some other industry players. Companies are implementing new product launch and product improvement strategy for capturing higher market share.

EHR optimization
Life for physicians in the digital era has changed for better and for worse. Physicians now have unprecedented real-time access to electronic data entry, storage, and retrieval. Advances in health IT have transformed the profession and translated into new opportunities for the betterment of healthcare through value-based care, population health, and precision medicine. However, most physicians find themselves also facing new challenges, like increasing workloads, increasing documentation requirements, and longer work hours. Adding to the complexity is the rise of consumerism and patient expectations. These changes brought about by the shifting nature of healthcare and adaptation of health systems to their respective contextual challenges in turn often bring EHRs into question because of their centrality in clinical documentation and other processes.

Most EHRs were and continue to be blunt instruments for routine data entry and mundane documentation tasks that create inefficiencies affecting the day-to-day sentiment and satisfaction of physicians. As healthcare advances further into the new digital age, physicians want to be better able to respond to the demands made of them, be more ready for future challenges, and love their jobs.

Breaking the barriers. A second wave of EHR innovation and deployment (or EHR 2.0) seeks to drive the collective aspirations of the industry and its professionals forward into a new wave of clinical documentation and workflow transformation. These next-generation capabilities aim primarily to improve value-based care workflows, optimize data capture to maximize reimbursements, and improve clinical user experiences, efficiency, and effectiveness. As a result, multifaceted efforts to address the overarching physician technology dilemma – advancing patient care through EHRs while still ensuring respect for and happiness of doctors – are increasingly taking shape in the form of EHR optimization initiatives. One key objective of EHR optimization is to reduce the physician’s workload and fatigue. In addition, open APIs and interoperability standards (e.g., HL7 FHIR) are enabling better exchange, interpretation, and utilization of data. Whereas the core premise of EHR adoption involved data entry and rendering the provider organization as data rich, the post-EHR adoption era is more about shifting the focus on improved clinical outcomes and becoming data driven.

Finding a way forward. EHR optimization cannot be ignored. The EHR, in its current state, is a non-ambient technology that establishes an operational barrier between physicians and patients as a by-product of time and attention spent on it. As a result, every EHR implementation holds room for improvement. The key to effective EHR optimization is to start with the end in mind, where an ideal end-state of clearly envisioned optimization goals must be established. The optimization journey can then be conceptualized as a framework of continuous improvements, made over time toward the defined end-state. These improvements entail those that can be driven and delivered by vendor capabilities, organizational efforts, and end-user utilization beyond the post-implementation phase to realization.
EHR optimization would not be worthwhile without the addition and realization of value. Common questions that providers will deliberate on are: whether the EHR is currently streamlined or challenged; whether it is better to rip and replace or optimize the her; and, in the latter case, whether optimization should be holistic or modular. While there is no common consensus or one correct way to address such post-implementation questions regarding EHR optimization, because it is largely context specific, there is some degree of commonality among provider organizations that view it as advantageous.

Optimization enabled. Putting an EHR optimization strategy into action requires a focus on the functional areas that lessen the workflow burden: documentation and workflow redesign – enabling consistent 360-degree view through provider-focused clinical data presentation that caters to specific end-user needs, specialties, personal preferences, and patient dispositions, as well as unifying the end-user experience across different interfaces and EHRs; system readiness and openness – ensuring that system latency, start-up, and log-on issues are nonexistent and that the foundational, structural, and semantic facets of data exchange, interpretation, and use require no effort; mobility and real-time access – leveraging mobile and tablet devices for seamless charting, charge capture, prescribing, and telemedicine via anytime, anywhere access to records across digitally unified care settings; user experience transformation – integrating systems and applications through a platform that is clinically adaptive and introduces better personalization features, user/role-based capabilities, and intuitive interfaces; and innovative advancements – adopting emerging technologies like artificial intelligence and ambient interfaces to enable more automated and hands-free workflows (e.g., bots, voice recognition, gesture-based controls, etc.).

Furthermore, optimization can address common hindrances attributed to EHRs: defining and standardizing inefficient and inconsistent end-user experiences; addressing system latency, start-up, and log-on issues as well as interoperability challenges; bridging disjointed patient handoffs, enabling patient-identification functions, and improving communication; reducing design inefficiencies and workflow bottlenecks (e.g., death by a thousand clicks, high mouse miles, alert, and reminder fatigue); configuring workflows to cater to specific patient panels, service lines, and specialties; enabling more personalization features, user/role-based capabilities, and intuitive interfaces; and ensuring training and support are not time consuming and demanding.

Way forward
EHR optimization can no longer be ignored. Physician frustration with EHRs and the impact of that frustration, combined with other dynamics, has become highly pervasive and felt industry wide. Physicians have a tremendous role to play in advancing patient care in the new digital era, and this requires that they feel respected and function as the best version of themselves. Physicians and patients hold a vital and historic symbiotic relationship that, while being transformed by the digital revolution, must always be humanized.