Moving Beyond EHRs: What Lies Ahead for Healthcare Digitization?

Chris Ingersoll, Principal Architect at Innovaccer
Chris Ingersoll, Principal Architect at Innovaccer

As our economy has become increasingly digitized, we are generating a massive influx of personal data. Across industries, the winning companies are those that have successfully harnessed the value of that data to create unique and personalized experiences for their customers. How we shop, travel, and handle our finances have been entirely transformed in ways that delight, engender loyalty, and generate repeat business.

Healthcare, however, has generally lagged behind other consumer industries in truly creating such a personal and efficient experience for their customers. This is not a reflection of the proficiency of physicians and caregivers but of the technology systems that support their efforts. These systems are primarily designed to manage the discrete clinical events that drive the revenue cycle of provider organizations.

While the COVID-19 pandemic has accelerated many innovations for the benefit of the health consumer ー think telehealth, mobile registration, remote patient monitoring ー it has also expanded the health data generated outside the four walls of the provider. The transformation in consumer experience in healthcare will come from a fully realized patient-centric view of the myriad of digital silos that comprise a patient’s health. This shift in perspective from point-of-care events to the holistic patient is foundational to achieving the industry goal of lowering costs while increasing care quality and efficiency.

How far along are we in our digitization efforts? 

Healthcare has been behind other industries in digital advancement ー a Harvard Business Review study five years ago placed the industry at number 17 out of 20. The advancements in digitization have tended to be isolated to distinct points of care as reflected in the rapid adoption of electronic health records (EHRs) over the past 15 years. Driven by the Affordable Care Act and Meaningful Use, today 96% of hospitals and 84% of practices record the patient record electronically.

However, rarely does a single point of care contain the complete health record of a patient. The typical patient sees many providers at different locations which often use different clinical systems. He or she may go to independent labs or pharmacies, may use personal health devices, be monitored at home, or may spend time in rehab or a skilled nursing facility. Much of these events are reflected in claims from their insurance provider which may provide a wider net of coverage but with less clinical depth than the typical EHR record.

As an industry, we are rigorously recording health digitally which is a significant advancement representing years of IT spend. This investment hasn’t yet realized the promised return on investment in quality and experience. The next generation health system anticipates and preempts potential health issues for populations of patients and becomes a system that operates at the 99+% of patients’ time not spent with their physician.

Putting together healthcare’s disparate data sources

The inability to find the right information at the right time can cause gaps in patient care, which in turn can lead to delayed care or even the wrong care and higher costs. On a network level, fragmented data can result in limited visibility of the network shortcomings and growth opportunities and poor collaboration between care teams within the same organization, resulting in lower patient satisfaction. Unification of data sources is a first step toward eliminating errors and redundancies in patient records and improving efficiency in care powered by contextual information. 

A unified source of information一inclusive of the clinical, financial, environmental, and administrative一can provide a holistic view of the network operation as it improves population health and network growth. Additionally, data integration on a single platform promotes efficient acute-ambulatory and ambulatory-ambulatory data sharing. A comprehensive view of the network will help organizations monitor care gaps, acuity, quality metrics, patient volume, network leakage, and more.

Are EHRs up for this task?

It helps to standardize on the same EHR system across all sites but often health systems aren’t fully deployed on the same EHR system for a number of reasons. Costs and timing considerations can delay this migration for all practices, especially the newly acquired. Some specialties such as oncology or ophthalmology have EMRs tuned to handle their specific clinical requirements. Many networks incorporate independent practices, aligned for referrals and orders, or that are members of Clinically Integrated Network. These are practices for which there lacks the IT governance to mandate a switch.

And often such a mandate is needed given the costs of acquiring and deploying the software, re-training staff, and lost opportunity for other investments. Many times practices are happy with their EHR and do not wish to switch.

More importantly, while EHRs were promised to power population health with greater efficiency and cost savings, it’s no secret that this promise has fallen short of its mark. EHRs are digitized provider records initially designed as a paper chart replacement. Not only does the record document care but it is also used to drive the billing process. EHRs are transactional systems by nature, and as healthcare shifts to a quality-oriented, value-based system of care, they can’t keep up. 

What is the alternative? 

A possible alternative is a hub of information, where information from the various EHRs is extracted, scrubbed, normalized, aggregated, and leveraged to provide intelligent insights in care delivery. Such a data platform combines the network of EHR data with other sources, including in particular health plan financial transactions, generates insights and plugs contextualized information into the disparate network workflows that drive patient care.

Incorporating a data platform can help healthcare organizations connect data across systems and settings, enabling a flow of information and actionable insights that result in better patient outcomes and lower costs. Such cross-network data aggregation supplemented with comprehensive content including quality and financial analytics, care protocols, and dashboards can also ensure the development of more relevant and personal healthcare solutions suited to the custom needs of whole-person care.

Upon such a foundation, an ecosystem of interoperable solutions can be delivered to help healthcare organizations of all types improve clinical, financial, and operational outcomes. It can be deployed at a significantly lower total cost than a rip-and-replace strategy of EHR consolidation and with far less disruption and headaches. This deploys IT strategically to create new value versus the blocking-and-tackling of EHR conversion.

Most importantly, it lays the groundwork to truly improve how the system focuses on the ongoing patient health as it transforms and personalizes the experience of receiving care.