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Cloud to the rescue: EHR as a service drives future of healthcare

Electronic health records in the cloud, provided as a service, can be the cure for the digital ills providers and patients suffer. It also brings new opportunities.

Electronic health records are no longer a nice to have. The future of medical care—with lower costs and better care as the goals—requires systems where medical records are easily transportable. Existing systems are helpful, but the lack of standards in stand-alone systems, coupled with utilization issues, has thwarted the potential of EHR.

EHR systems have long promised big goals: to increase efficiency and accuracy, to improve collaboration between physicians and care teams, and to ultimately achieve greater clarity in treating patients. Yet efforts overall have fallen short, in part because hundreds of EHR systems are in common use, from the stand-alone doctor's office to the large healthcare enterprise.

Medical professionals regularly need to work with different healthcare systems, each using their own version of an on-premises EHR system, requiring medical staff to learn multiple systems. In addition, large healthcare systems have been struggling with getting their existing systems to change with their businesses: Consolidation, insurance changes, and even the pandemic have changed the ways and the speed at which their existing EHR systems have had to adapt.

All this creates a window of opportunity for EHR as a service.

"There's still plenty of room for improvement," says Mutaz O. Shegewi, research director of provider IT transformation strategies at IDC Health Insights. With cloud-based EHRs, he says, patients and medical workers are finally able to work in ways EHR advocates have long envisioned. EHR as a service explicitly addresses the problems that have troubled stand-alone EHR systems. And by providing a solution to these problems, EHR as a service is attracting investments even from the healthcare systems that were early adopters of first-generation EHR.

As EHR moves to the cloud, especially as EHR as a service, long-promised aspirations are beginning to become reality, offering the promise of not just replacing paper medical records but enabling technology for advances in patient care, the majority of which require simpler and more flexible access to each patient's medical records.

Crash course: EHR as a service

EHR as a service is the logical growth path for medical records. It brings a level of flexibility and availability to a world traditionally dominated by huge numbers of large racks of paper records. The overhead alone of maintaining all that information on paper has resulted in significant inertia. Making EHR available across the medical enterprise in an as-a-service form eases the transition to a fully digital platform.

However, it is more than a cloud version of traditional EHR software. Healthcare providers have heard the pitch of the benefits of EHR before but have remained skeptical. Much of what ailed earlier EHR systems is rooted in the limitations of on-premises software: complex technical issues, inability to scale and widely integrate, inability to share between institutions and providers, design and reporting inflexibility, and difficulty of use, to name a few. Moving to a cloud-based, software-as-a-service model jettisoned those issues and finally freed the potential in the software that healthcare providers had long sought.

In a nutshell, EHR as a service provides cross-platform mobility and anytime, anywhere access, as well as several other advantages.

One big one: It better prepares the healthcare system to deal with the unexpected, such as the pandemic. If there is one thing 2020 taught the medical industry it is that the ability to make rapid transformations in an industry that favors stability and predictability is now a top priority. With cloud-based EHR, what has been a roadblock to rapid transformation can suddenly become an agile part of the business model.

How does that happen? Cloud-based EHR relieves IT burdens, spurs innovation, and creates new opportunities.

As Daniel Cooper, managing director at consultancy Lolly:co, says, "It removes the burden of security from the healthcare provider and frees them to concentrate on patient care. Previously, the healthcare provider must assume the burden of both security and privacy of patient records. With the ever-growing cyber insecurity, the burden is getting heavier and heavier."

Please read: Why healthcare is such a juicy ransomware target

Just as important, EHR as a service enables scaling to accommodate long-term growth and spikes in demand. "If the health facility grows and you need a larger capacity to hold patient records, scaling is seamless and you will have zero issues with data integration," Cooper adds.

Cloud-based EHR is trending

For all of these reasons, cloud-based EHR is trending upward, with total spending projected to double from an early-adopter perspective in 2018 to a $44 billion market by 2023, even as healthcare organizations have already heavily invested in EHR systems and IT budgets are tight.

Keep in mind that the basic premise of EHR isn't new. It's the idea of EHR as a service gaining significant traction in the industry that is causing the shift in attitudes about what a good EHR system represents. According to a report by the global nonprofit organization Healthcare Information and Management Systems Society (HIMSS), EHR digital data quality suffered "a long list of concerns, including incompleteness, duplication, inconsistent organization, fragmentation, and an inadequate use of coded data within EHR workflows."

According to HIMSS, its earlier studies, as well as studies conducted by other organizations, found that initial adoptions of EHR applications worked well independently for local needs but not across clinician disciplines. For more than 4 million U.S. practitioners, EHR is handled by one or more of 100 certified EHR systems. And, HIMSS points out, "they all started using these EHR [systems] at virtually the same time."

"Despite market saturation and investments made, U.S. hospitals were still replacing and making additional investments in EHRs," Shegewi says, meaning workflow optimization is key for organizations focused on next-generation clinical documentation. "EHR ranked first for cloud workloads, reflecting perceived benefits of a move to the cloud for clinical documentation," Shegewi notes, adding that European providers are on a similar trajectory.

Please read: Electronic health records are beginning to deliver on their promise

Other technologies trending or maturing in healthcare—including Internet of Medical Things device integration and remote patient care—are driving the need for cloud-based EHR as well.

The growing connectivity between smart things and devices within hospital settings and diagnostic procedures comprise a significant market force that is pushing the need for interoperability and automation, including notations and results on patient records. The continuing surge in telemedicine and remote patient care is proving to be a second but equal market force.

According to Forrester's predictions for this year, "Consumer interest in digital health devices will accelerate as individuals appreciate the convenience of at-home monitoring, insight into their health, and the reduced cost of connected health devices." As such, the need for real-time integration of results from these numerous consumer devices into patient records will grow and continue the momentum of cloud-based EHR adoption and expansion rates.

Please read: Telehealth: How virtual can medicine get?

But other driving forces are pushing cloud-based EHR adoption as well. An American Medical Association (AMA) report reveals a long-standing but worsening problem: physician burnout: "EHRs brought many benefits to doctors' offices and hospitals, but they also shifted a number of clerical responsibilities to physicians, from billing and coding to prescribing medicine electronically."

study published in JAMA before the pandemic began pushing doctors to extreme levels of physical and mental endurance found that EHR use factors added significantly to physicians' stress and burnout. Specifically, the study found these EHR factors to be the worst offenders:

  • Information overload
  • Slow system response times
  • Excessive data entry
  • Inability to navigate systems quickly
  • "Note bloat"
  • Fear of missing something
  • Notes geared toward billing, not patient care

This is no small matter, with the AMA predicting the situation could quickly lead to a shortage in clinicians.

"Physician burnout as a whole is a multifaceted problem, but people are retiring early or going part time because they're spending so much time on the computer, they don't feel they get enough time to take care of their patients," says Philip J. Kroth, MD, MS, a lead author of the study cited in the AMA report. He chairs the biomedical informatics department at Western Michigan University Homer Stryker M.D. School of Medicine.

"More and more of what we enter into the record is for things other than direct patient care, like quality control and to support billing," Dr. Kroth says. "We should be able to redesign the workflow process so more people can help enter data into the EHR to reduce this burden on physicians, or at least make the data-entry requirements more judicious."

Beyond all the factors behind the uptick in EHR as a service is a need for continuity. That means future-proofing to stop the budget overruns caused by EHR being handled as an acute rather than chronic problem. Cloud-based EHR enables fast iterations, updates, upgrades, and innovations in an efficient, cost-effective manner, with little to no downtime.

Future-proofing to manage change

Savvy healthcare organizations know that every penny in the budget counts and that there is no room for waste or heavy IT forklifts brought on by the winds of change. That is truer today than ever, with COVID-19 overwhelming critical care units and staff while draining profits from elective surgery, routine diagnostic care, and other patient care revenue streams.

In such a demanding environment, it is crucial to be ready for anything.

"It's imperative to keep pace or outpace change," says Oded Shihor, strategist and worldwide healthcare industry lead, GreenLake portfolio management, at Hewlett Packard Enterprise.

"Moving EHR to a cloud platform lifts considerable burdens for healthcare organizations and makes it easier to respond to new challenges and opportunities," Shihor explains. "For example, moving to HIMSS level 7 can be accelerated, complexity can be reduced, and hybrid EHRs can be better managed after M&A consolidations." The HIMSS eight-stage model (0-7) measures healthcare organizations' adoption and utilization of EHR functions.

There are many other marked and notable advantages in features and functionality of next-generation, cloud-based EHR. According to IDC, those include but are not limited to:

  • Advanced interoperability integrations and emerging standards
  • Clinical workflow optimization catering to end-user needs, specialties, preferences, service lines, and patient dispositions
  • Broadening use cases such as population health, social determinants of health, claims, consumer research, and patient-generated data integrations
  • Community developer ecosystems and platforms such as EHR application marketplaces
  • Role-based workflows and specialty EHRs
  • Enterprise-wide mobility for seamless charting, tablet mobile charge capture, and e-prescribing—all with anytime, anywhere access
  • Cross genomic repository and real-world evidence integration
  • Personalized care planning and predictive therapeutic analytics
  • Genomics-driven analytics (actionable genomics and genetic risk profiling)
  • Anticipatory medicine (exome sequencing) integration
  • Remote patient monitoring to manage chronic conditions
  • Patient financial engagement, such as claims-based AI algorithms, propensity-to-pay dashboards and tools, cost of care patient responsibility calculator, and educational tools

Managing change, challenges, and opportunities are the keys to providing premium patient care and sustaining the enterprise.

This article/content was written by the individual writer identified and does not necessarily reflect the view of Hewlett Packard Enterprise Company.