EMRs are Not Enough
By Adam Klass, Chief Technology Officer, VigiLanz
Healthcare technology has entered into the “post-EMR” era. Regardless of the varying sentiment about the benefit of EMRs on patient care, there is little dispute that the implementation of these big-dollar platforms have been game-changers, finally pushing healthcare into the digital age. Now that most of health care has been digitized and is running EMR technologies, the big question is simple — Now what? Implementing an EMR is just the beginning of the journey toward transforming healthcare into a real-time, predictive intelligence environment for patients, caregivers and executives. In short, EMRs are not enough to meet today’s demanding, rapidly changing healthcare environment.
EMRs are documentation and workflow systems. They do not easily align with clinical processes, often interfering with clinician productivity, creating usability challenges and even disrupting rather than enhancing the provider/patient experience at point of care. Despite the billions of dollars invested in EMR technology, these rigid, transactional data platforms are not enough to deliver real-time, patient-centric care that improves safety, quality outcomes and population health in a continuously evolving environment.
Achieving these goals requires a new category of technology that leading healthcare analysts call “Enterprise Intelligence Resources” (EIR). EIR platforms integrate real-time clinical intelligence, business intelligence and predictive analytics, and complements existing EMR systems. Built on flexible, interoperable data architectures, EIRs integrate massive amounts of data from multiple disparate sources and use robust, exception-based, temporal rules, algorithms and events to tell frontline clinicians and healthcare leaders in real time what is happening – and likely to happen – with their patients. With these actionable insights, they can improve patient outcomes, enhance operational efficiency and support quality initiatives.
Improve patient outcomes
EIRs transform powerful real-time and retrospective metadata into opportunities to impact care immediately through better informed decision-making, helping to reduce medical errors, lower patient readmission risk, address gaps in care, optimize clinical interventions and better protect patients from life-threatening risk. To highlight just a few of today’s patient safety challenges: Every hour, every day, 136 people in a hospital are affected by sepsis. 82 people contract a Healthcare Acquired Infection (HAI) and 217 people are affected by a preventable Adverse Drug Event (ADE).
Let’s take a closer look at how one key EIR platform capability, Business Intelligence (BI) and Predictive Analytics, can integrate with clinical workflow to dramatically improve patient outcomes and reduce costs associated with sepsis, which affects more than one million patients annually and accounts for nearly $29 billion in healthcare spending. Research has determined that the earlier the intervention, the significantly lower the mortality and morbidity. EIR platforms capable of integrating real-time clinical intelligence with BI and predictive modeling, providers can identify immediately at-risk patients earlier, methodically and automatically monitor their diagnostics and alert clinicians to initiate appropriate interventions as needed, then monitor progress so treatment can be adjusted according to defined protocols.
A similar approach can be used to address other potential patient safety risks, including DVT, CDiff, MRSA, toxic hyperkalemia, glycemic control, surgery site infections (SSIs) and medication error. Pharmacy surveillance can be used to automatically screen and monitor patients based on a hospital’s own internal guidelines, providing oversight that helps anticipate and prevent ADEs. Continuous automated surveillance also helps identify and investigate infection outbreaks, drug resistance patterns and hotspot disease trends.
The most effective EIRs engineer these real-time intelligence services to fit effortlessly into clinicians’ workflows, aggregating and processing data across proprietary, crowd-sourced and evidence-based real-time, smart rules. By generating only essential alerts and avoiding alerts for issues clinicians would typically address in their daily work as part of good medical practice, this approach minimizes alert fatigue.
Enhance operational efficiency
As reimbursements decline and the Centers for Medicare & Medicaid (CMS) and other major payers levy hundreds of millions of dollars in penalties on hospitals with poor readmission rates, hospitals face increased pressure to reduce financial and operational risk. Given that the majority of variable costs in healthcare result from clinical decisions made at the point of care, the ability of EIRs to deliver real-time clinical intelligence can drive operational improvements. For example, antimicrobial stewardship can decrease use of high-cost drugs and decrease antibiotic utilization.
With their advanced predictive capabilities, EIRs can also zero in on critical business intelligence insights that EMRs lack the capacity to uncover, helping hospitals to analyze performance, improve efficiency and streamline care delivery. EIRs can link cause and effect to help reduce readmissions, improve LOS monitoring and close gaps in care, as well as provide internal and external benchmarking.
In addition, EIRs can support quality initiatives by tracking Meaningful Use metrics, improving workflow and care coordination, and reviewing key performance indicators across service lines and departments.
We have seen clients utilize this technology to achieve double-digit reductions in major cost areas like drug spend within one year of adopting cloud-based versions of these services.
Affordable and cost-effective
EIRs delivered using the software-as-a-service (SaaS) model avoid putting additional burdens on hospital IT departments whose resources are likely stretched thin already. The solutions can be implemented rapidly – generally within 90 business days – and seamlessly integrated with existing EMR systems, without any special hardware requirements.
Other valuable EIR features to look for include:
- EIR platforms should interface with any dataset, EMR or other system.
- Multi-modality. The platform should be accessible via any stationary or mobile device, including tablets, desktops, laptops and smartphones.
- True real-time capacity. A continuous real-time service, versus batched information or report-centered intelligence, processes EMR and other health data every one to two minutes and delivers alerts tailored to individual patient information.
- Data should be encrypted and the platform should be managed in highly secure, redundant data centers.
- Hospitals using proven EIR platforms often see measurable improvements in clinical outcomes and cost savings within 12 months.
- Continuous learning. A data warehouse that stores metadata collected through continuous clinical surveillance can leverage analytical models to determine causal relationships and drive quality improvement.
- Expert vendor support. Implementation, configuration, training and ongoing support from an experienced vendor services team helps hospitals optimize EIR performance. The team should also include clinicians who can ensure the technology is consistently meeting clinician needs and effectively supporting patient well-being.
With clinicians and hospitals alike recognizing the limitations of EMRs in today’s value-based healthcare environment, we’re rapidly entering what Gartner describes as the “post-EHR” era. EIRs that integrate with EMRs but move well beyond them will increasingly provide invaluable real-time clinical and business intelligence. Equipped with actionable insights that inform smarter decision-making – both in the moment and on a longer-term basis – clinicians and healthcare leaders will be able to optimize clinical outcomes and patient safety, support preventive care and reduce costs across the continuum of care.
Adam Klass, is Chief Technology Officer of VigiLanz, a leading provider of SaaS health care intelligence and predictive analytics. VigiLanz supports a large and growing community of hospital CMOs, CMIOs, CIOs, quality teams, infectious disease and control specialists, pharmacists and other clinicians dedicated to real-time inpatient and outpatient care. VigiLanz is shaping the 21st century vision for real-time health care by delivering the right data, to the right people, at the right time and improving patient care and operational effectiveness.