Blog from June, 2019

Samara Rosenfeld 

Ordering gamma glutamyl transferase tests through the search engine function of an electronic health record (EHR) reduced orders from 36,000 to about 1,000 per month, according to the findings of a study published in the American Journal of Managed Care.

The research team found that ordering tests through the search engine function, rather than from two other lists that appear on the main screen of the EHR, led to a dramatic reduction in orders. The team returned the gamma glutamyl transferase test option to one of its original places on the main screen, which caused the numbers to spike to 18,000. When the test option returned to its original place in all the lists, the numbers jumped to more than 35,000.

The solution could lead to a reduction in costs.

Researchers set out to evaluate if changes in how laboratory requests are presented in the EHR would lead to less testing.

Gari Blumberg, M.D., from the family medicine department at Tel Aviv University, and the research team compared the numbers of gamma glutamyl transferase tests ordered at different times. The researchers changed the parameters on the main laboratory screen of the EHR.

Researchers at the laboratory at Leumit Health Services in Israel removed the testing option from the main screen in 2014. With the option removed, physicians could only order the test if it was specifically searched for.

After two months, the main screen option partially returned, then it went back to its original status.

When the gamma glutamyl transferase tests could only be ordered through the search engine function, Blumberg and the research team saw a 97.3% reduction in the number of orders.

While the number of test orders has increased since July 2015, less are ordered now compared to before the intervention. As of 2018, physicians ordered about 25 to 34 tests per 1,000 health maintenance organization members. Prior to the intervention, physicians ordered 51 tests per 1,000 members.

The study authors noted that there is a slight inconvenience when the test cannot be ordered on the main screen of the EHR. But using the search engine led to a dramatic decrease in the number of tests sent.

“Because the doctors are still able to choose the test should they feel it necessary by actively searching for it, it follows that the increased convenience was the most likely cause of the overordering, facilitated by the use of shortcuts,” the authors wrote.

The researchers wrote that while convenience is positive when it saves time, if it leads to overtesting, physicians do not gain much and are wasting money.

Kate Monica

Amidst concerns that EHR technology worsens provider burnout, one study showed 64 percent of clinicians say the systems have a positive effect on satisfaction levels.

New research suggests EHR technology may have a relatively positive reputation among healthcare professionals, with nearly 70 percent of surveyed providers reporting that EHR systems improve care quality.

This insight comes from a recent Future Health Index 2019 report commissioned by Philips.

Researchers surveyed 3,100 healthcare professionals and 15,000 healthcare consumers across 15 countries to gauge opinions of EHR technology in the current digitized care system.

While researchers found many healthcare professionals see the benefits of EHR technology and other health IT tools in clinical care, providers in most countries are not using health IT to its fullest potential.

For example, 80 percent of providers have engaged in health data exchange with other providers within their own care facility. However, only 32 percent of surveyed clinicians have shared patient health data with providers outside their facility.

Fifty-six percent of providers who do not share patient health data with outside hospitals and health systems lack the health IT infrastructure to do so. The lack of EHR interoperability between different provider systems restricts the scope of health data exchange for half of clinicians.

Fifty percent of providers also cited concerns over data privacy and security as an impediment to health data exchange with care facilities outside their health system.

In addition to this general lag in advanced health IT use among care professionals, many clinicians also struggle with EHR implementation and administrative burden.

“Many countries experience challenges with the implementation of digital health records and there is a common assumption that healthcare professionals feel these records can simply add administrative tasks to their workload,” wrote researchers in the report.

Health data exchange between patients and providers is similarly low. Only 36 percent of surveyed patients who use patient portals or other health IT regularly share their health information with their provider. Meanwhile, 26 percent of patients share health data with providers when they have a specific concern.

Despite these drawbacks, most surveyed healthcare providers agree EHR technology has had an overall positive impact on care quality.

Furthermore, 64 percent of surveyed providers said EHR technology has had a positive impact on provider satisfaction. Fifty-nine percent reported that EHR use has helped to boost patient health outcomes.

“Additionally, 57 percent of healthcare professionals report that, in the past five years, their experience has been positively impacted by having access to patients’ full medical history,” wrote researchers.

Patients who engage patient portals and other technologies to access and share their data also generally report higher levels of satisfaction.

“Those with access to their digital health record report better personal experiences in healthcare and better quality of care available to them than those who do not have access,” stated researchers.

Specifically, 82 percent of patients with access to their EHRs rate their experience with their providers as good, very good, or excellent. Comparatively, 66 percent of patients without access to their EHRs reported having a positive experience with their provider.

“The data suggests that there could be greater potential for individuals’ uptake of digital health technology and mobile health apps if usage of these technologies was more frequently recommended by healthcare professionals,” authors wrote in the report.

“There is also evidence to suggest that individuals will be more likely to use digital health technology if it’s easier to share data with their healthcare professional,” they added.

Overall, patients who access and exchange their own digital health information are more likely to have a positive perception of care quality.

“The challenge, now, is to encourage more individuals to share data with their healthcare professional, giving healthcare professionals access to more up-to-date and complete information that will allow for more coordinated patient care,” suggested researchers.

Mike Miliard

Even five years after go-live, many health systems aren't realizing the full value of their electronic health records, says a new Chartis Group report. Gaining clinical and financial ROI depends on a "sustained, organized approach."

Why aren't more hospitals realizing the benefits of their electronic health records? And what are the organizations that are capitalizing on their EHRs doing well that others should try?

Those are questions asked and answered in a new report from the Chartis Group, which surveyed some leading health systems that are leveraging their IT systems to enable big improvements in length of stay, reductions of adverse drug events, boosts in nursing efficiency, fewer unnecessary lab tests, speedier cash collections, better preventative care and more.

The report, by Douglas Thompson and Tonya Edwards, MD, shows that even five years after attaining Stage 4 on the HIMSS EMR Adoption Model, where the benefits of improved clinical decision support should begin to show up system-wide, most hospitals still haven't fully realized them.

Moreover, "increased costs of operating more sophisticated EHRs leave some further behind financially, leading critics to claim that EHRs have been a huge waste of time and money."

But it doesn't have to be that way. Indeed, the report shows how many leading health systems have realized big ROI on their EHR investments with improved patient outcomes and cost efficiencies.

"Texas Health Resources  saved an estimated $10 million from a greater than 60 percent reduction in adverse drug events at three hospitals one year after EHR go-live," for instance. "Sentara realized $57 million in annual EHR-driven savings, net of expenses, and a 50 percent reduction in hospital mortality ratio. And Memorial Hermann saved over $2 million annually from increased use of just six standardized electronic order sets."

What are they doing right that other health systems aren't?

Illustrated by a series of anecdotes from those organizations and others, Thompson and Edwards show that too few hospitals understand that extracting lasting value from IT implementations requires a "sustained, organized approach," bolstered by a "firm commitment from business leaders."

And beyond mere technology, effective deployments depend on those health systems understanding the enterprise-wider cultural shift and specific process changes that will be necessary from clinicians and staff.

It's key, they said, to stay focused on "benefits realization amid the distractions of the design, build and implementation process," not just until go-live day, but aftward, "when the next big change initiative comes along."

Based on its experience with and review of several hundred hospitals nationwide, Chartis found that the most successful ones share some EHR best practices in common.

The health systems gaining the most from their technology investments are those who have bought their EHRs with an eye toward using them for specific strategic outcomes – and know how important it is to steer system implementation and optimization toward those goals.

Those hospitals also know that the most beneficial aspects of an EHR don't happen just by flipping a switch and running the system, but when the new tool is used to help change how day-to-day work is done. It's the difference between "automation" and "innovation," said Thompson and Edwards.

They also said that "without a formal structure, benefits realization is left to chance – and benefits don’t happen by accident," pointing to the value of "dedicated resources, well-defined roles and robust governance."

It's also critical to measure the system's benefit after go-live through quality indicators, financial data and other key performance indicators, to ensure its value is manifesting itself, they said. "If you don’t measure it, you won’t achieve it."

The value of a properly deployed electronic health record system is hard to argue with. And even if some hospitals are struggling to show ROI after Stage 4 of the HIMSS EMRAM, the advantages that can be gained by pushing higher up that ladder can be substantial.

We've shown, for instance, how Los Angeles-based Martin Luther King Jr. Community Hospital joined just 6.4 percent of other American hospitals at Stage 7 by treating that goal as a formal project, with a prep team and a designated project manager to lead the charge. By optimizing its EHR, the hospital was able to make big gains on an array of clinical use cases.

The Chartis Group report shows the value of approaching EHR rollouts strategically, and part of that is a robust and clinician-focused training program. As we showed this week, physician dissatisfaction and poor user experience have less to do with software design and much more to do with the quality of system training. The better the training, the better the care delivered and the outcomes reported.

"Health system leaders should be satisfied with nothing less than achievement of the strategic clinical and business objectives of their technology investments," said Thompson and Edwards in the Chartis Group report.

"While the majority of health system EHRs have not delivered on that promise, there is ample evidence that with clear goals, careful planning, good governance, and ongoing measurement and commitment, any organization can expect real, substantial benefits from EHR use," they added. "Organizations that have already implemented or upgraded their EHRs can use the principles and methods described above to optimize their EHRs to deliver measurable benefits."