In a recent whitepaper from consulting firm KPMG LLP—a Delaware limited liability partnership and the U.S. member firm of the KPMG network—senior executives at the firm looked at several clinical information system optimization strategies that patient care organizations could put in place to enhance clinical outcomes.
The authors of the Dec. 2015 paper, “Eliminating the Disconnect: Strategies That Bridge EHR Systems and Outcomes,” argued that “As population health management, improved outcomes and reduced costs become more entwined with reimbursement under value-based healthcare, effective use of clinical systems will be essential. These efforts require care coordination beyond hospital walls, which necessitates tools and processes that allow the seamless collection, sharing, analysis, and clinical use of data across facilities and locations. Optimizing EHRs [electronic health records] and other clinical systems represents an undeniably cost-effective and prudent approach to achieving these objectives.”
Indeed, the paper pointed out many of the core issues that physicians nationwide have been grappling with when it comes to EHRs: poor usability, time-consuming data entry, limited interoperability, and interference with the patient/provider relationship. Michael A. Beaty, principal at KPMG Advisory, and co-contributor of the whitepaper, works with hospitals all over the country that are trying to upgrade their EHR systems and bring them into the more modern era of healthcare. Beaty, based in Atlanta, recently spoke with Healthcare Informatics about his research, why so many physicians are dissatisfied with EHRs, and what it will take for the industry to move past the EHR adoption stage and into the optimization stage. Below are excerpts of that discussion.
We all know that the government has invested significant dollars into EHR implementation, but many providers have not gotten far past the adoption stage of the technology. What is your take on why this is?
There are technical limitations, there are regulatory limitations, and there are people limitations—all of which, combined, have put us into the situation we are in today, and we really have a long ways to go. There is quite a dense vendor landscape today in health IT; at HIMSS you saw the wide variety of choices that healthcare provider buyers—the CIOs, CMIOs, and CFOs—have available to them. When you contrast that to other functional areas like finance and human resources, you have a much smaller suite of products to choose from. So in the EHR world, there are hundreds of choices you can choose from to enable your organization with [one]. On the vendor side, there has been less innovation in the last couple of years and more of a focus on getting volume to remain viable.
Also, there is the heavy burden of dealing with regulatory demands via meaningful use (MU). So you have significant market competition which creates pressure in pricing and talent issues in terms of development of talent, as well as a heavy regulatory burden that has in effect driven the product roadmap for many of these vendors. Meaningful use as created a situation in which a vendor may have a very unique and differentiating capability in its product, but if it didn't map to MU Stages 1 and 2 over the last few years, it’s not a viable choice for any of the buyers.
When you look at future functionality requirements, such as the ability to do complex care coordination or manage populations, while some people are headed down that path, lots of health systems aren’t. Some need it and desire it, while a significant amount of others just aren’t there right now.
You also mentioned the limitations of the feds and the end users as reasons for the lack of EHR optimization across the industry. Can you expand on that?
The federal government funded the meaningful use program to incentivize health systems to invest in technology. That is a massive optimization strategy form the feds, and a lot of health systems really did take advantage of those incentives to bring their platforms up to the state-of-the-art in the EHR world. But those federal guidelines did not appropriately address—nor did they intend to address—physician usability, clinician satisfaction with the systems, redundancy of data entry, or time required to document certain things. That will come in the next generation, but in the MU-version of these platforms, while that was a great opportunity to upgrade the overall technology platforms for health systems, that upgrade path was not driven by the true end user, which is the clinician.
Michael A. Beaty
What do you define as true clinical information system optimization?