Exclusive Article By Tiffany Casper, RNC, CNM, MSN
President, EMR Consultants
Thanh Tran, CEO of Zoeticx, Inc. also contributed.
This byline marks the inaugural byline of Tiffany Casper who recently joined your EMR Advisors Board. On this occasion she writes about the decline of EMRs, but finds some areas that could bring them back to being key components of the hospital and valued by medical professionals.
As EMRs are being tasked with new communications activities, including increasing popularity as voice recognition conduits by medical professionals, it appears their value might be on the up swing. If they came improve connectivity and begin partnering with third-party vendors who can provide interoperability, they might be the beneficiaries of some badly needed PR.
Article :
Dissatisfaction with EHRs among nurses has escalated to all time high of 92%, according to the Q3 2014 Black Book EHR Loyalty survey. Disruption in productivity and workflow has influenced job dissatisfaction according to nurses in 84% of U.S. hospitals. Meanwhile 85% of nurses state they are struggling with continually flawed EHR systems; 88% blaming financial administrators and CIOs for selecting low performance systems based on price and government incentives.
In addition, a study of 1,000 physicians by the MPI Group found that nearly 70% of physicians say the current electronic medical record (EMR) systems have not been worth it and most physicians do not believe the current systems often leave hospitals and patients with nothing more than EMR band-aids.
Some of the chief complaints are that current hospital EMR systems are passive, not active, offering no data analysis or push technology to escalate the right data to the right caregiver at the right time. This forces medical professional too often conduct a patent record scavenger hunt, looking through multiple EMR databases, trying to locate patient records when critical, lifesaving seconds are ticking away in an emergency room. Records confusion when caring for a patient that can lead to medical errors. Also lack of middleware usage, the technology behind the “glue” that enables EHR systems to connect, championed by 2.0 healthcare vendors like Zoeticx.
However, some medical pros believe that if EHRs could implement the spate of third-party connectivity tools currently available to overcome lacking interoperability components, there could be a sea change in attitudes among medical pros. EHRs with voice recognition software are gaining popularity among many physicians who are discovering great resource savings and other benefits.
Some practices also have it added into existing systems by consultants such as Atlanta’s Contact EMR Consultants who implement popular voice products, including Dragon Practice Medical Edition 2 and NoteSwift that bridges voice dictation with EHRs for medical offices.
EMR Speech Recognition Market Growing
According to a recent KLAS Report, nine out of 10 hospitals plan to expand their use of front-end speech deployment. The ROI from the technology was clear for these hospitals, according to KLAS. Facilities interviewed saw a higher impact in nearly every category measured in the report: reduced transcription costs and documentation time, and more complete patient narratives.
The American Health Information Management Association (AHIMA) noted in medical office practice brief that speech recognition can improve and enhance clinical documentation in many ways, especially as the demand for more documentation of every encounter is on the rise, and there aren’t enough experienced medical transcriptionists to meet current and future demands.
A report issued by the Health Information Management System (HIMMS), Essentials of the U.S. Hospital IT Market/Support Services notes that of 22 applications measured for projected market growth, dictation with speech recognition was one of two rated as “aggressive” with a 20 percent growth rate from 2013 through 2014. It also noted that applications overall appear to be growing, but demand for dictation with speech recognition may have a sizeable market yet to be harvested.
Physicians who have implemented voice recognition software found benefits such as being able to conveniently and quickly record patient histories, physical examinations, progress notes, consultations, and discharge summaries. Other benefits have included:
- Improved clinical workflow
- Higher levels of service to patients and responsiveness to referring physicians
- Billing documentation and AARA compliance
- Greater accuracy than typing data in an EHR
Meanwhile, savvy healthcare 2.0 connectivity vendors are incorporating voice dictation systems into their offerings to gain broader acceptance among medical professionals. Earlier this year Zoeticx integrated Nuance’s SpeechAnywhere technology into its software to enable medical pros hands free EHR connectivity.
EHRs Migrating to Central Communication Hubs
Meanwhile, EHRs appear to be migrating beyond their original intent. The increase in infectious diseases, whether Ebola, the enterovirus D68 or the flu, are making healthcare increasingly complex, involving more players in terms of patients, providers, administration, insurance , governmental bodies and now CDC screeners at airports. However, this also leaves more risk for miscommunications and patient error.
The system of medicine is no longer centralized, but distributed over many care providers. This drives home the need for attention to issues with communication, miscommunication and omission of vital information between healthcare providers, something the EHR is expected to catch, but doesn’t. When critical patient data is missed by the care team, delays in treatment and death can result.
Communication lies at the root of medicine and can take many forms. EHR’s have not only replaced their paper predecessor for narrative documentation, but they are becoming the central hub for all clinical, administrative and quality aspects of healthcare. Although EHR’s were not designed as a communication tool, the EHR is encroaching on this role as well. When looked at from this perspective, we must be careful of the unintended consequences this may lead to.
The ability to communicate concerns, open action items that need following up, the interpretation of labs and tests, disease management , interventions and now admissions data are becoming components of EHR’s. This data is used by many to try and produce a complete and accurate picture of the care provided. The data is easy to collect, store and transmit, but it is the meaning that stems from this data, coupled with the current clinical context of the patient that is important for timely and accurate care to be delivered.
EHR’s are just databases capable of storing any type of data and at any level of complexity. The storage of data is not the utility of an EHR; the utility comes from use of the data where meaning is applied to the data collected. Physicians and other providers depend on the information to make management decisions. Given the many possible places any piece of healthcare data can be stored in the EHR makes health care pros jobs more challenging.
The problem arises when a physician does not search in the area where the data is recorded or a critical piece of information was not readily available in the standard workflow of the physician. Although the recent Ebola issues have many on edge, this same clinical scenario is present with all types of patient data. Collection of a blood glucose value in a diabetic can easily be hidden from another providers’ view when it is recorded in a location within the EHR that is not part of that providers’ standard workflow.
Adopting this mode of searching for all relevant pieces of data also has issues as well. When information is searched for and not found, one concludes it does not exist. This leads to the problem with duplication of tests or additional time tracking down who entered the data and where which can lead to a patient’s death.
As the EHR expands its role is as a central repository for all types of healthcare data, providers are collectively using the data to manage patients, all from a different vantage point. Face to face communication will always exist in healthcare, but given the current limitations of EHR technology, we must look for different solutions to this communication issue.
Most of the EHR platforms have a comprehensive data model to incorporate the vast amounts of information generated on a daily basis so there is no need, at least at this point, to scrap this functionality. We need instead to expand the capabilities of the EHR so that the data contained in the record can be utilized in a more dynamic, actionable way. Looking at the communication problem from this angle, we have the ability to use existing systems and available technology to address the issues that arose in the Ebola case.
“Push” Communications Platform Tied to Subscription Model
What is needed in healthcare is not another data storage application, but instead a dynamic, real-time communication platform that sits on top of the implemented databases. We need to proactively use the data when it becomes available. A system using push technology coupled to a subscription model for patient care where all members of the team are subscribed to a patient that they have some impact into the care being delivered.
This subscription can be as short as a shift or remain with the patient as they transition through different phases of care. Not everyone on the team needs to be responsible for ever piece of data generated in the course of care, but this aspect can also be managed so that data and information is communicated to those who are responsible for certain aspects of care. Although abstract, this model can be applied to any patient situation, be it as an ambulatory office visit or a hospital admission.
Understanding the issues that arise, such as a missed travel history, fever symptoms, or any other critical piece of health data illustrates the immediate need to implement connectivity software across all EHRs. A nurses’ section of the system needs to also be available to doctors and open to all to view simultaneously whether in the U.S. or the nation’s of West Africa.
This can be achieved today with push technology and middleware software from Zoeticx and others. Zoeticx can even tackle expanded uses of EMRs through open APIs that enable medical record app developers to easily create new solutions that can address the increasing need for EHR communication.
With the projected growth of voice recognition software and the expanded need for communications, EHRs might become a medical pros best friend yet with some help from connectivity integrators like Zoeticx and other 2.0 healthcare vendors.
