Hospitals and healthcare institutions have had a slow-paced, and sometimes acrimonious start to their digital transformation. However, the onset of the COVID-19 pandemic revitalized the need for an optimized EHR system. With patient care becoming virtual, and the likely changes that engulf the ‘new normal’, data scientists, doctors, and nurses are looking to embrace an EHR system that supports interoperability and prioritizes quality data. 

We spoke to Dr. Fatima Paruk, CMIO at Microsoft and ReMedi Health Solutions CEO, Sonny Hyare, MD, over a virtual fireside chat and discussed the challenges that healthcare providers experience with EHR data, how the COVID-19 pandemic impacted health data, the use of data within EHRs, as well as the future of data in healthcare.

To listen to the entire conversation, click here.

What major challenges are healthcare providers dealing with that are directly related to how they use EHR data?

When thinking about the big data revolution, Dr. Fatima Paruk talks to us about the missed opportunities in the treatment of healthcare data. In her words, “I have found that healthcare data has generally not been treated as a first-class citizen throughout my career. It has very much been an afterthought, where data is now being increasingly collected in electronic medical record systems.”  Although there are ways to extract structured data, the culture hasn’t favored it or practiced it enough to optimize it. This results in free text data that is hard to use for secondary purposes. This trickles down to not being able to better support informed decision making for better patient care. Dr. Paruk tells us, “Our patients are a lot more complex these days, we’re responsible for coordinating care across a number of different settings. And often, we just don’t have the information from the right person, to the right person at the right time.” 

Challenges Related to EHR Data

One of the challenges with EHR data is that it isn’t part of our workflows. Dr. Paruk says, “It needs to be within our native workflows that we’re used to leveraging on a day to day basis. If I’m utilizing an EMR and that’s going to be the center for documenting patient courses and histories, as a clinician, I’d like to be able to understand what a patient has had at any other site or what their medications are without having to be a data entry clerk.” 

The recent ruling on interoperability is a precursor of the vision of what’s to come. However, a lot of organizations just don’t have a way to get there. Dr. Paruk adds, “The US healthcare system is incredibly complex. And so, as we think about the prior authorization across different payers, that can sometimes be an interesting challenge as well.” 

Another challenge with managing data in healthcare is patient ownership, Dr. Paruk says, “We need to think about patient ownership of data and how that translates to transparency for health systems and how it can be utilized to unlock value and inform clinical decisions.“

What could healthcare companies do better when it comes to their EHR data?

When thinking about the treatment of data, Dr. Sonny Hyare recounts an analogy that best describes the situation, “If your car breaks down somewhere in Wyoming and you are from Tennessee, the mechanic would have more information on your car than if you were to go into an emergency department (ED) in a similar situation… We’re using billion dollar systems to collect data and provide care, but they’re not talking to each other.” And so, it begets the question:

• How much data are we actually collecting?
• How much of it is meaningful?
• Why is this information not being disseminated across the nation?
• Why do we not have access to it?  

Data Integrity in Healthcare

When discussing data integrity, Dr. Hyare adds, “And what you see is that a lot of health systems are using claims data to bring accuracy to data versus what is in the EHR and what physicians are actually looking at.”  Providers face hurdles where they spend a lot of time looking for information, and if the information they find accurate, does it have integrity to inform critical clinical decisions? 

Dr. Paruk affirms this in saying, “Setting data governance is key…. If there’s questions about the data coming in, how trustworthy is it? Is it something that I can make medical decisions about patient care upon? Because if we’re not making the right medical decisions based on correct information, we would be causing harm.” 

What has the current health crisis taught us or shined a light on when it comes to the efficient use of EHR data?

The COVID-19 pandemic changed the world in unimaginable ways. There was a system wide shifting of gears to Telehealth and virtual care. Prior to the crisis, there was a slow uptake of virtual care with sporadic instances of virtual visits. Dr. Paruk foresees virtual care as it’s here to stay, she said, “I believe that we’ll have longer term success as it relates to virtual care, it’s innovation fueled by crisis. Individual health visits are benefitting from going digital. With finite starting and ending times, virtual care makes it easy to stay on track. The value is currently limited because of the lack of integration. Telehealth is occurring over FaceTime and Zoom, and for Microsoft it occurs on Microsoft Teams. While Microsoft specifically has done a lot of work on their Teams platform to make it very usable, there is still a long way to go as it relates to the integration of these virtual care platforms with the system of record. So just being able to manage the scheduling, the billing, the coding that comes out of a standard virtual care visit, whether it’s an outpatients visit or virtual rounding visit that happens on the inpatient side.” 

Barriers to Technological EHR Innovations

About the barriers of entry, Dr. Hyare talks about how the innovation progress is being slowed by the difficulty for tech companies to seamlessly interface with EHR vendors. While the market is ripe with different softwares and technologies, their challenge is being able to interface with the “Epics and Cerners” of the world. From an institution’s standpoint, they have to think about how they would integrate with their current EHR, but because they can consider vendors who have been in the tech healthcare space not just tech solutions. 

Dr.Paruk reminds us of other teething issues that come with virtual care adoption. Providers should be conscious about the patients that benefit from virtual care; and consider varying technological capabilities and whether they cater to patients who could be hard of hearing or seeing. To which Dr. Hyare reminds us about the very real problems where physicians face challenges with adapting to this model of entry. There’s a certain dissonance when they are tasked with these data entry systems, and because they aren’t accustomed to this they don’t see the benefits. However, to truly move towards a model that is value-based, EHR is the only thing to lead us in the direction. 

Shifting Resources Within Healthcare

COVID-19 also coerced a lot of institutions and businesses to reinvent how they can recapture their loss of revenue streams and innovate ways to make up for losses they saw. While hospital systems have not been functioning the same, with elective procedures on hold and patients not being billed optimally, the healthcare industry had to consider how they were going to navigate the new normal. Dr. Hyare points out that as much as the CARES act was of help to bigger institutions who may not see many changes from the pandemic, the rural hospitals who have leaner operations will make changes in how they work. “I remember seeing a graph where there was an exponential increase in administrative staff, but the number of residency spots stayed the exact same. So that’s something that we’re going to see, going back into more of the clinical side of things and not have it be this overarching corporation like operation.” 

To which Dr. Paruk confirmed, “There’s a number of opportunities that are certainly out there as it relates to improving efficiency and getting doctors and clinicians back to what they do best, right? Removing the administrative burden from them and just really getting them to deliver out on just care.”

Describe how the role of the electronic health record has evolved throughout your career and how you would like it to transform in the next five years.

Dr. Paruk talks to us about how EHR systems were first meant to just assist hospital systems with billing, and at the time they were independent from workflows and efficiency. “What we see now is with the widespread physician utilization and adoption of EHRs across the field, we’re seeing far more natural workflows. You’re seeing more physician technologists like myself and Sonny in this space. I’m also seeing that the EHR companies now need to add value to maintain stickiness. So we were seeing increased consolidation in the field. About 10 years ago, there were hundreds of EHRs out there, we’re certainly seeing fewer and fewer large giants who have taken over the market. We’re also seeing increased specialization of workflows within EHRs according to specialty. So, you know, it’s, basically looking at the type of content and so on that’s available within EHRs for the purposes of clinical decision support, managing patient throughput, so on and so forth.”

The Future of Healthcare Revolves Around Physicians