Understanding Electronic Health Records: An Inside Look

More and more health systems are transitioning to electronic health records (EHRs) these days. EHRs allow physicians and providers to maintain continuity, quickly accessing notes from past sessions and even sending charts to other clinics or systems as needed. Physicians are expected to take accurate and comprehensive notes, but are given a wider scope of categories to report on than in past.

EHR adoption is also boosting quality reporting and pushing more systems away from fee-for-service care and towards a value-based model. The advanced data captured by EHR usage allows for more advanced quality reporting and has driven organizations like the Centers for Medicare and Medicaid Services (CMS) to introduce new metrics by which quality can be measured. If done right, this new quality reporting can lead to significant discounts for high-performing, accurately-reporting systems.

It can be hard to fully understand the value of an EHR, though, and both patients and physicians need to have a comprehensive understanding in order for EHRs to be as effective as possible. Here are some facts on what EHRs are, how systems are using them and where they might go in the future.

EHR Basics

Nowadays, health systems have a lot of EHR programs to choose from. There are even EHR reviews to help systems and patients determine which are best. At their base, however, most EHRs have some similarities.

EHRs are, at their most basic, digital versions of a patient's chart, which would have been captured on paper in the past. EHRs function as a real-time record of a patient's medical history and status. They are updated every time a patient visits a provider for anything and everything from a yearly checkup to a major surgery.

A patient's EHR will contain comprehensive, advanced data on that patient: not only will treatment history be available, but also immunization dates, allergies, past radiology images, lab results, treatment plans and more. An EHR is a full picture of a patient's health: when physicians are recommending treatment plans, prescriptions or even surgery, an EHR is an invaluable tool in understanding what the best course of action is.

Advanced EHRs sometimes also have tools that give physicians recommendations on the best course of action for a particular patient. Such tools take advantage of data analysis and an evidence-based approach to recommend the ideal solution based on the patient's current status and history. Access to these kinds of tools make physicians even more effective and give them a collective knowledge base to draw from when treating patients.

EHRs aren't just specific to one practice or provider, either. In fact, EHRs are specifically built to be shared. If a patient goes to a general practitioner, an optometrist, a podiatrist and two different pharmacies, EHRs are built so that their record will follow them to each of these places and can be updated by each provider in turn. Comprehensive reporting of this fashion allows for all providers to offer better care based on a full view of each patient's health, regardless of whether they've ever seen the patient before or not. Effective use of an EHR takes the guesswork out of medicine and guarantees that patients will receive the best possible care from every provider they visit.

Implementing an EHR

While many systems are already using EHRs in their practices, some are slow to adopt more advanced systems or are still working on upgrading to the latest, greatest EHR program. While there are a lot of options in the EHR market, the process for selecting the best EHR remains similar for most systems.

The first step for any system is to plan to implement an EHR. Adding one of these systems is a complex process that will involve most parts of a practice or system, and isn't something that should be done on a whim. Specific staff and financial resources have to be allocated to work on the system. In addition, all staff should be notified of the transition, as backups of past information will have to be made and training will have to take place.

Another big part of planning is research. When systems are looking to buy an EHR, their employees need to understand what they're looking for. Figuring out how EHRs work and the different requirements of the system will help create a sense of which EHR the system needs. Certification and regulation also play a big part in any and every EHR system, and should be thoroughly understood. There are two main types of EHRs, and both have advantages and disadvantages:

Cloud-based EHRs can be quickly launched without much upfront cost for hardware or software and are maintained offsite by experience professionals. However, systems have to trust that the companies managing their cloud servers will keep their data secure and can't always access their own data to the level of an on-site EHR.

Locally-hosted EHRs allow systems to have complete control of their own data and don't require an advanced internet connection. However, they require more IT know-how for maintenance and backups.

Once a system is ready to start implementing an EHR, it has to find the right one. Shopping for EHRs can be complex, but the best way to do it is to determine the features and aspects that are absolutely necessary and look for an EHR that meets all of those requirements. Systems can also look at what other systems are using and how well it works. Interviewing experts in the field can be a great way to get insider information on what EHR systems are good for certain applications.

After finding the right vendor, a health system or practice needs to contract with the vendor who will provide the EHR. Negotiations should keep in mind the cyber-security and safety of the EHR, data management, risk and liability and how to manage the transition. A good vendor will be prepared for all of these questions and will help the system it contracts with manage all the aspects of the transition for the smoothest, easiest possible implementation.

Systems would be smart to retain a legal professional with experience in the EHR field. As the EHR field is still growing, having expert knowledge and experience is a valuable asset that can help systems get the program they want without excess cost or risk. Legal experts can also make sure that systems are doing their due diligence before even starting the shopping or contract negotiation processes.

Once an EHR has been selected, it's time to actually implement it. In this step, patients and staff should all be informed, as the transition may cause minor hiccups or other issues in scheduling and treatment. EHR vendors and legal experts should both provide guidance and information to make the transition happen as smoothly as possible. In addition, organizations should have a project plan in place to reinforce milestones and make implementation run smoothly. With dedicated staff resources and effective training, it can be easy to get an EHR implemented and working effectively within a system very quickly.

After implementing an EHR, the system should keep a close eye on how it's being used. An EHR, after all, is made up of living documents, and is a living system itself. Making improvements to workflow and optimizing the use of the EHR is vital to make it a worthwhile investment and continue to derive value from it. Implementing a feedback system can be useful: having management and executives review feedback from employees every three or six months can give a good idea of what needs to be improved to make the EHR as effective as possible.

EHRs in the Future

EHR adoption rates continue to rise, and it doesn't look like this trend will stop anytime soon. As EHRs become more integral in health systems around the country, different trends will change how they are implemented or used, as well as the kind of reporting they inform.

While EHR adoption rates are high, EHR satisfaction rates are significantly lower, showing a need for improvements in the future. Companies offering improved EHRs will have a massive advantage in a mostly-dissatisfied marketplace, and the race for improvements is on. Overall, physicians are the arbiters of the next big change for EHRs: more often than not, physicians dislike the EHRs they are using, so systems that implement physician-friendly programs will be poised to reap the rewards.

One of the biggest challenges for systems is the often-exorbitant cost of implementing an EHR program. While large systems may have the capital to spend, many small systems do not. Improved pricing will have to be considered in the future to capture remaining sections of the health care market that have not yet adopted these programs. In addition, improving efficiency in EHRs will be important in saving physicians time, therefore improving cost margins for systems even more.

Additional changes may come in the way physicians are asked to take notes. Many physicians report feeling burned-out or overburdened by note taking and reporting requirements in their EHRs. Faced with a heavy patient load and little time to take detailed notes, physicians make mistakes or rely on copy-and-paste reporting, leading to records becoming less reliable and far more confusing. For EHRs to be successful in the future, they will have to allow for easier note taking and reporting to lessen the burden on already-stressed physicians.

In the future, EHRs may also get a big boost in accessibility. Physicians and patients are both clamoring to be able to access records on mobile phones and tablets, and this kind of program is finally starting to be seen. Patients can see some details of their chart online or on mobile apps, allowing them to request prescription refills, schedule appointments and even sometimes receive treatment from their phones. As the world continues to become more mobile friendly, patients and physicians can only expect more access to EHR data from mobile devices, creating a huge boost in data accessibility.

Hopefully, EHRs will also become more accessible in terms of their searchability and ease of use. Physicians are asking EHR vendors for more tools to make finding information easier inside EHRs. In basic terms, these programs are powerful, but lack the user-friendliness that could make them truly excellent. Improving searchability is a big step towards improving physician workflow and preventing burnout and frustration. Optimization is the future if systems want to offer better care without making life and work unmanageable for their staff members.

Depending on changes to political administrations in 2020 and beyond, systems may also see increased regulations towards EHR vendors and programs. Right now, these programs are still so new that there isn't much in the way of standardized regulations for EHR vendors. Flaws in the system are being exposed and some vendors are being caught engaging in shady or unscrupulous behavior. Cases like this will certainly propel increased regulation forward to protect systems and consumers.

There are some changes come to EHRs, however, that are impossible to predict. Technology is progressing at a breakneck pace, and developments created today would have been unthinkable ten years ago. In even five years, the EHR market may be totally unrecognizable when compared to what it is today. It's important for systems, physicians and even patients to stay abreast of the new developments in this growing market. From mobile accessibility to ease of use, EHRs will continue to change and to integrate into other changing technologies.

EHRs are vital in the modern healthcare field, and adoption rates prove that they aren't going anywhere quickly. These programs allow systems to standardize reporting, giving providers a convenient view of a patient's entire medical history and providing the data to give an effective diagnosis and create the best possible treatment program. It's clear that EHRs are important to providers and patients alike, and in future, they will likely become even more vital in helping give patients the care they truly need while helping systems report their high-quality value-based care.

Nothing is perfect, however, and EHRs have a long way to go before physicians are entirely satisfied with them. Changes in technology will motivate countless changes in EHRs over the next few years. EHR vendors also have to step up and improve accessibility, standardization, ease of use and other important aspects of their programs in order to keep systems using them. Right now, vendors are in a race to develop easier, more convenient products, and systems have to be on the lookout for them. Early adopters will provide physicians with what they have been searching for and create better environments for both work and care. The future of health care lies in improved, effective EHRs.