By Meg Tully
Ordering a test at a hospital used to mean sending a paper order through a pneumatic tube and waiting for it to arrive at the laboratory. Now, physicians can order tests with a single click.
As a result, inpatient stays are shorter — just one cost saving that can be associated with the growth of electronic medical records over the past decade.
But hospitals have spent billions on these systems, and doctors complain that they are interacting with screens more than with patients, undermining patient care and physician productivity.
As federal lawmakers consider broad changes to the U.S. health care system, software developers, hospital leaders and doctors are debating how electronic records will fit in, and whether they can fulfill the promise to improve care and boost efficiencies.
The Healthcare Information and Management Systems Society, a global organization working to improve health through information technology, reports that hospitals that have more sophisticated systems do better than expected in quality measures evaluated by the Centers for Medicare and Medicaid Services.
And as new software is developed, changes could be even more profound.
“The U.S. health system, individual hospitals, won’t see returns for those types of programs for years and years and years — but they will come,” said Blain Newton, executive vice president of HIMSS Analytics. “Reduced costs, increased efficiencies and improved clinical outcomes. You create this entire ecosystem of technology-enabled health care delivery that wouldn’t be possible without the [electronic medical records].”
‘Meaningful use’ program
Much of the growth of electronic medical records came as a result of a 2009 law that created a “meaningful use” incentive program for implementing electronic records. Newton thinks of the original investment in setting up electronic medical record systems as basic infrastructure, much like a highway, but argues continued voluntary investment beyond government incentives shows the value that health care organizations are seeing in electronic systems.
But in practice, not all doctors are happy with the way electronic medical records often require physician data entry — sometimes hundreds of data points.
It’s too early to tell if these records result in benefits like fewer unnecessary tests. In some cases, however, they can actually make it easier to do things like order costly tests or prescribe expensive drugs, said Dr. Vikas Saini, a cardiologist and president of the Lown Institute and co-chair of the affiliated Right Care Alliance, a clinician- and patient-led health care reform movement.
Saini says he hopes to see electronic medical record systems improve as part of broader health care changes, noting that some doctors now report feeling less connected to patients as a result of the electronic record systems.
“Certainly it’s OK if we are changing in order to improve things,” Saini said. “But the general feeling that we were hearing was that most of the records were to maximize billing and maximize the capture of revenue, and not necessarily to enhance the clinical interaction or the communication or the clinical decision-making.”
Those systems can end up reflecting backroom deals for certain pharmaceuticals or require heavy data entry by doctors to justify higher billing, Saini said.
He suggests a government-mandated interoperability standard, less data entry for doctors and allowing patients to have meaningful access and control over their electronic medical records.
From a software perspective, vendors are trying to make electronic record systems easier to use.
Corinne Proctor Boudreau is the senior solutions manager for physician experience at MEDITECH, which has about 25 percent of the nation’s electronic medical records market share. She said the company decided to make large-scale changes to its software about five years ago.
In 2015, the company’s online electronic medical records product went live with a modern consumer interface and more personalization options.
“We had the courage and passion as an organization to say we can do things differently,” Boudreau said.
Still, the demand for what providers are expected to document has continued to grow, she said. Solutions include delegating data entry to other members of the care team and easing regulations that require extensive data entry.
At Johns Hopkins Hospital in Baltimore, as at other hospitals, reducing the burden on clinicians is a challenge, one senior administrator acknowledged.
Linda Kline, vice president of health information technology for Johns Hopkins Medicine, said that the hospital system now has record-sharing capability throughout its hospitals, outpatient centers and physician practices. Health care professionals have already implemented important patient-safety features using electronic medical records and are able to access records across the system.
She said that as technology evolves, it will likely become more intuitive for clinicians and offer more personalized options.
And as that happens, she sees technology as the key to a future where doctors can use technology to predict and track a course of care, or analyze measurements — the size of a wound, for instance — in ways that they never have before.
“And particularly at a research organization … we do our research and we bring our science to the bedside,” Kline said. “And in order to do that in today’s world, you have to have those discrete data elements — to try to pull it together to look at how we can best treat the patient in the future with a similar condition.”