As healthcare providers face unprecedented challenges fighting the Covid-19 outbreak worldwide, electronic health record (EHR) systems are having to adapt to shifting requirements for patient care.
“We have never had an international crisis of this proportion in the lifetime of the current EHR,” said Dana Bensinger MSN, RN-BC, informatics nurse specialist and client solution executive at consulting firm CTG. “Once things settle down, there will be a lot of analysis of how well our systems performed, what our areas of vulnerability are, and how we fix them for the future.”
With a surge in demand for hospital capacity, one of the challenges facing hospital IT staffers is figuring out how to quickly deploy EHR systems to alternative care locations.
EHRs are designed to allow medical information about patients to be readily available to doctors and healthcare workers across practices and wherever a person needs treatment.
Because of the haphazard rules and regulations in place when EHRs were set up in the last decade, interoperability between systems has been an ongoing issue; some vendor-specific EHR systems don’t always work well with rival systems, hindering the flow of critical medical information.
“To effectively use the EHR in [alternate] locations, you need to build the department units in the software, extend Wi-Fi, deploy hardware, printers, and test that everything works as expected,” said Bensinger. “That takes an IT army to pull off.”
These have, in some cases, been set up away from hospital premises. The list of locations ranges from tents erected in parking lots to university dormitories and even entire conference centres.
“There is a challenge for the IT departments to get connectivity into there to deploy the EHR and other systems they need at the bedside,” said Mike Jones, a research director at Gartner.
IT staffers are also required to update EHR systems as additional clinical workers are drafted for duty. “Some health providers have reported that they're being kept very busy with setting up processes for quickly on-boarding new staff and changing their role within the system,” said Jones. “That requires a change in configuration of the EHR in terms of their role-based access, and in some cases it is creating new user accounts.”
As workflows are updated to deal with the Covid-19 response, it is important that EHR systems don’t impede clinicians’ work, are straightforward and seamlessly integrate with existing care delivery processes. “The EHR workflow really needs to disappear into the background as providers ramp up to address Covid-19 capacity surges,” said Jones.
“At a fundamental level, all EHRs need to be working as intended — now more than ever,” said Bensinger. “And not only clinical workflows and features. You want to be sure that the registration and billing components are also collecting accurate and complete information.
“This is where health systems can be proactive and test their system features, or have them tested, to be sure all are correctly working.”
Integrating telehealth with EHRs gains importance
There is also demand for new EHR functions to address patient needs, particularly around remote healthcare. Telehealth has become a key way doctors can continue to work with and treat patients from a distance, especially as more communities call on residents to stay home.
“The ‘digital front door’ is really key to how providers should be responding to Covid-19, in terms of access, triage, even treatment,” said Mutaz Shegewi, a research director at IDC.
For instance, screening capabilities in patient portals can be more efficient in identifying possible Covid-19 cases.
“If you are a patient and you are worried that you have respiratory symptoms, you go to your patient portal and your screener tells you that you probably do need to talk to a doctor, they can manage that for you right there within that patient portal infrastructure,” said Jeff Becker, a senior analyst at Forrester.
Virtual consultations are playing a bigger role, too. Although some EHR providers have built video capabilities into their platforms, for the most part that means integrating with third-party platforms such as Microsoft Teams, Zoom and Webex.
“[Healthcare providers] are trying to use as much of their existing unified communications platforms to do that if the EHR isn't up to it. So in reality, it is a combination of the EHR and other solutions that they can deploy more rapidly,” said Jones.
Interoperability remains a sore point
As providers attempt to incorporate data from different sources, existing challenges around EHR system interoperability could come to the fore.
“It is becoming super important that these EHR vendors are able to share patient records in an increasingly fractured care delivery environment,” said Becker. “The question becomes how do you integrate all of these new peer delivery centres, employee wellness centres, virtual visits, with traditional EHRs?”
While there have been attempts to improve EHR interoperability in recent years, both from vendors and government authorities, there is still a ways to go to ensure data can be sent between different software platforms.
“The fact of the matter is that interoperability is largely lacking and [for] a pandemic — a public health issue — data is central to any response,” said Shegewi. “We are not asking for a ‘magic wand’ approach to fixing all of nationwide health IT interoperability, but health providers’ organisations will be challenged in driving statewide, regional and even nationwide responses to this disease, without having the right interoperability measures in place."
Resolving interoperability issues is not an “easy fix,” he said. But with the Centres for Disease Control and Prevention (CDC) and EHR vendors offering guidelines around the documentation of patient data in relation to Covid-19, healthcare providers could see some improvements in their ability to exchange information.
“With government intervention and with all these stakeholders working in unison, there could be quick developments that may facilitate better responses to this outbreak,” said Shegewi.
Time to innovate
Shegewi noted that while healthcare providers and healthcare IT workers are under immense pressure in dealing with the ongoing pandemic, the demands to ramp up capabilities and introduce new capabilities could be a catalyst for improving EHR systems.
“This is a new challenge — and an opportunity, too,” he said. “It is allowing for providers to take the initiative on areas they may not have been considering scaling up before. Nationwide interoperability, telehealth, virtual visits: up until the outbreak situation, these were all in the status quo of being relatively slow and stagnant areas.
“Now you are seeing this rapid scale-up and a shift in models to an extent. And perhaps there are lessons to be learned that will hold in place and drive the industry forward towards being more digitally transformed and virtualised in future."