Marcus Perez, president of Altera Digital Health, has deep health IT expertise in many areas, working with healthcare provider organization clients ranging from Phoenix Children’s to Sarasota memorial Health Care System to Baton Rouge General to the Government of South Australia SA Health.
Perez knows the qualities of a highly usable electronic health record, and he’s interested in the intersection between EHR usability and flexibility – and how prioritizing ease of use can benefit a variety of roles and departments. He has a keen eye on ambient voice technology, which is fast gaining momentum across healthcare.
Perez works with healthcare organizations on what they’re doing to achieve and maintain financial stability as reimbursements trend downward and costs rise. Amid growing M&A consolidation, he also stays on top of what healthcare organizations of all sizes are doing to maintain independence. In this Q&A, he discusses why independence is important not only to providers themselves but also the communities they serve.
Q. What are the qualities of a highly usable electronic health record, and how can prioritizing ease of use benefit different roles and departments?
A. Flexibility is a major determinant of how usable an EHR is, and that can be broken down into three distinct yet interconnected components. Configuration is how the system is set up to make it operational and how different parameters and settings are adjusted to enable proper functionality.
Customization allows a healthcare organization to go outside of standard industry workflows and complete specific tasks differently than other organizations leveraging the same system. Third, personalization gives organizations the ability to manage the user experience so staff members can fine-tune EHR experiences to meet their individual needs and preferences.
While flexibility is crucial to usability, it also has its limits. If an instance of an EHR diverges too much from a standard implementation, that might add too many clicks to users’ workflows and make training a challenge for new staff members. Striking the right balance between flexibility and efficiency not only benefits clinical users documenting in the system, but also the IT staff responsible for setting up and maintaining it.
If users aren’t dealing with clunky workflows, they’re less likely to be submitting support tickets. In turn, IT teams can focus less on fixing problems and more on other, high-priority tasks.
Second, a highly usable EHR must reflect the way providers (and other users) think and perform their core essential duties. When EHRs first hit the market, many systems were designed with billing as the top priority. As a result, providers have been forced to conform to workflows often at odds with how they would otherwise deliver care or document.
Provider burnout is a multifaceted issue, but we know the increasing computerization of healthcare is a contributor, and we are seeing the technology side of the healthcare ecosystem start to course-correct. For example, more developers now see the value of involving real users in various stages of the design and development process.
Developers should want to build the right thing, and nobody knows the workflows of a physician, nurse or other provider more intimately than the people on the hospital floor or in the exam room every day. As an industry, we need to make documentation less of a burden and more of a byproduct of users’ other tasks.
KLAS recently released a study that found 40% of nurses who cite the EHR as a contributor to burnout plan to leave their organization within two years. Given the provider shortage many organizations are facing, we simply cannot afford to lose skilled, experienced providers because of bad user experiences.
Third, EHRs need to bring relevant, up-to-date data to the forefront for clinicians to provide a highly usable experience. This can only happen with seamless data exchange, and while much progress has been made, true interoperability is not our reality today.
According to ASTP/ONC data, 30% of hospitals are currently unable to engage in all four domains of interoperability (sending, receiving, finding and integrating data). As industrywide initiatives and frameworks like TEFCA and FHIR expand, we will move closer to a point where complete data follows patients wherever they choose to receive care.
That will have enormous benefits for providers and patients alike. From safety and outcomes perspectives, comprehensive medical records are necessary for providers to make accurate diagnoses and create effective care plans.
Similarly, giving patients greater access to their data empowers them as they play more active roles in their care decisions. To take this a step further for providers, EHRs should deliver actionable information and snapshots of trends in a single place (for example, via dashboards).
Providers simply do not have time to search through large volumes of data when they already have limited time with each patient. Healthcare will be better for everyone involved when providers can get in and out of the EHR quickly and move on to other tasks.
Q. How are hospitals and health systems using technology to help achieve and maintain financial stability as reimbursements trend downward and costs rise?
A. The contracts hospitals and health systems have with commercial payers change only so often (for example, annually) and Medicare and Medicaid rates are beyond their control. At the same time, costs of supplies and pharmaceuticals are steadily increasing. This means healthcare organizations have to get a bit creative to find untapped opportunities to widen their margins. Solutions that bring greater consistency and remove guesswork along the revenue cycle can help here.
For example, patient misidentification issues cost the average healthcare organization $17.4 million per year, according to AHIMA. Implementing an enterprise master person index can help ensure organizations bill the right patient the first time and avoid duplicating costly tests unnecessarily. Leaders might also want to reexamine their organization’s approach to charge capture, which is often subjective, leading to coding discrepancies between different staff members.
Organizations facing this issue should consider technology that automates the assignment of coding hierarchies to prevent missed charges and denials and get fully paid for the care delivered.
Artificial intelligence often is highlighted for its ability to transform clinical aspects of healthcare, but it has great potential to change administrative and operational functions as well. Robotic process automation is just one avenue worth exploring. RPA is a software bot that uses AI and machine learning to replicate actions, especially ones that are tedious and repetitive, typically performed by a person.
RPA is well-suited for several processes like claims processing, insurance verification and denial management. RPA works around the clock and removes human error, which means claims can get out the door faster and with greater accuracy to speed up the time to payment.
Additionally, offloading tasks from staff members means they can shift their attention to more complex tasks that require human intervention. Hospitals and health systems can also turn to technology that provides work queues for staff members in the business office.
These solutions automate task prioritization based on what will deliver the greatest value for the organization, so staff members can get to work instead of figuring out where to start and what to do next.
Healthcare generates an enormous volume of data, though a lot of it is simply not used, suggesting organizations have room to uncover more ways to increase revenue and cut waste. At the same time, if a hospital implements different systems that each have its reporting mechanisms, it is difficult to make sense of everything.
Analytical dashboards that aggregate data across systems can help by providing one place to find all the information financial and operational teams need to make decisions. Presenting real-time data in a logical, visual manner makes it easier for people to identify trends and find impactful opportunities for improvement.
Combining information from multiple systems also reduces the amount of reporting duties staff members need to execute before they can get the insights they need.
Q. Amid growing M&A activity, what can provider organizations of all sizes do with healthcare information technology to help maintain independence?
A. Preserving the independence of healthcare organizations of all sizes benefits not only those employed by them but also the people they serve. As healthcare and technology have evolved, patients have come to appreciate the convenience that less traditional care options afford, from telehealth to Big Tech urgent care offerings.
At the same time, there are many instances when patients value established relationships with providers and care continuity as well as providers’ understanding of the local community and resources available beyond the four walls of a hospital or practice. Maintaining independence is not just a business goal. It has real clinical impact.
Investing in technology cuts into budgets, but these investments should also be looked at within the broader context of the organization’s health and the long-term ability to continue delivering care to its communities.
Cloud computing and containerized services are a couple examples of technologies that can help healthcare organizations not only remain afloat, but also support innovation. Cloud-based EHRs can lower the total cost of ownership for a system by reducing the need for hardware as well as the resources needed for ongoing maintenance and updates.
Similarly, organizations leveraging systems built with containerized services can deploy new features and functionality incrementally. Both these technologies help reduce downtime, which is costly to organizations, frustrating for those temporarily reverting to paper charts, and potentially detrimental to patient safety and outcomes when health information is unavailable.
I also want to underscore that having an independent instance of an EHR helps support independence. With an independent instance, organizations own the system and can deploy updates at their own pace based on their unique priorities.
Investing in cybersecurity is also essential to preserving that autonomy. C-suites and boards have to be aligned on this with their cybersecurity teams. From new security frameworks to modern anti-malware systems, organizations need to constantly evolve because malicious actors are always just a step behind, waiting to exploit new vulnerabilities.
This is why instituting offensive cybersecurity practices is so important. As an industry, healthcare tends to be more reactive when it comes to cybersecurity, but as the saying goes, the best defense is a good offense. Organizations can use scanning software and services for vulnerability assessments and penetration testing to identify any points of weakness in their systems.
To take this a step further, organizations should consider creating internal “red teams” that simulate breaches. Red teaming not only tests the security controls of your systems, but also tests the vigilance of staff members responsible for identifying and reacting to breaches to find opportunities for improvement before an actual incident occurs.
Finally, healthcare is a complex industry. From the smallest private practices to the largest health systems, organizations of all sizes must adhere to many of the same regulations, do the same reporting and so on. Adding another piece of technology into the mix may feel necessary yet daunting.
Outsourcing might be the right option for some organizations. We saw this frequently throughout the pandemic, from a clinical perspective, in the form of travel nurses and other contract providers.
Depending on the geography and organization, it can be challenging for organizations to maintain the right level of staffing in their IT departments or find the qualified, experienced talent needed to fill highly specialized positions in the billing office.
Outsourcing only certain functions instead of an entire department is also an option so internal staff members can stay focused on day-to-day tasks that keep systems running and cash flowing. Healthcare is a business, but it’s a business of people.
Suppose an organization doesn’t have enough people in its administrative and operational departments. That is a threat to its ability to support care delivery and keep the lights on without losing its independence.
Q. Ambient voice is picking up momentum in healthcare. What are the various use cases for it and what needs to happen for more widespread adoption?
A. Ambient voice is an exciting, emerging technology in our space, as it helps address many of the challenges we’ve already discussed. Ambient listening technology “hears” interactions between providers and patients to transcribe what they say and help create a clinical note.
Not only does this reduce the amount of administrative work a provider needs to complete, but it also fosters a more natural environment for clinical encounters so providers can focus their attention on patients without technology getting in the way.
Dictation tools, in use for some time, have helped reduce time spent documenting, but they sometimes created awkward situations. Providers may not be comfortable dictating notes in front of patients, and patients may not understand the documentation-specific terminology providers dictate. Because ambient listening technology sits in the background passively, it removes those issues.
Building AI on top of ambient listening brings this technology to another level. AI models can take the free-text transcript created from the clinical encounter and automatically populate the structured sections of the medical record with the various data points to reduce the number of clicks a provider makes to complete documentation.
Additionally, conversational analytics can help provide a quick snapshot into an aspect of the patient’s health. If a provider is speaking with a patient about managing diabetes, for instance, an AI-enabled ambient voice tool might generate a summary of the patient’s A1C test results to help the provider identify trends during the visit.
This use case is an excellent example of how AI can play an assistive, complementary role for providers without removing the human elements from healthcare interactions.
As these technologies advance, some developers are exploring ways to offload even more tasks from providers’ plates, such as entering prescription or lab orders into the system automatically. However, this can create unintended consequences, from patient safety issues to unnecessary, costly testing.
Order entries often require more granular detail than what an ambient listening tool might capture from a clinical encounter, and you can’t automate a workflow if there is any ambiguity around the data as it may not be mapped properly.
As a happy medium, organizations could leverage AI-enabled ambient listening that queues up orders for providers that they then edit as needed and submit themselves. For all these levels of ambient listening technology, the most significant barriers to more widespread adoption are time and money. When budgets are tight, making new investments is always a challenge.
As early adopters measure the efficacy of these tools, I think more organizations will see how they can help save providers time, increase patient throughput, and improve experiences for patients and providers alike.
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