The role of EHR extensions in enhancing patient care

Abby-PolichBefore the advent of electronic health records (EHRs), a patient’s interactions with a doctor were documented on paper records, which were available only at that point of care. Sharing patient data with another facility required a phone call or fax, and how quickly the physician obtained the record depended upon the responsiveness of the organization on the other side of that dial tone. The slower the data transaction, the higher the likelihood of a negative impact on patient care. The 2009 HITECH Act accelerated the adoption of EHRs and the development of health information exchange (HIE) capabilities, increasing the accessibility of valuable patient data across health systems, and ultimately improving the care received. The healthier the data, the better the insights, thereby leading to healthier people. While the digitization of health records has certainly improved data accessibility, healthcare organizations need an explicit strategy for sharing data that provides a foundation of trust for patients and confidence for clinical care teams. Health systems extending their instance of their EHR to other healthcare providers is one way to build this foundation. Leveraging EHR extensions through a host-affiliate relationship allows health systems to work together to achieve a holistic view of patients and provide better care.

EHR extensions offer clinical and experiential benefits

Making information easy to access is critical to both providers and patients, and EHR extensions provide tremendous benefits to both. When a patient visits multiple specialists, clinics, or hospitals within an affiliated network on a single EHR platform, providers will have access to all clinical data in one record. Providers now know the details of the care received outside their immediate clinical setting and can provide the patient with better care. This builds trust between the patient and provider, strengthening the relationship.

Clinical outcomes are critical to healthcare systems; EHR extensions inevitably improve them. Instead of waiting for a fax or a phone call from another clinic, affiliated providers have access to the patient’s record, making care decisions more accurate and efficient. When a patient is referred to a specialist within the affiliated network for procedures or diagnostic testing, other members of their care team can simply look to their EHR to ensure the best outcome for their patient. With all the patient’s notes, results, and diagnoses available to the provider, EHR extensions reduce expensive and inconvenient duplicative testing. Integrated reports support more seamless transitions of care for patients and reduce the likelihood of readmissions. A complete picture of the patient’s clinical activity allows providers to identify missing information and close gaps in care to improve quality and clinical outcomes for the patient.

Extending an EHR enhances patient care – and requires preparation

Extending an EHR to an affiliated organization is the beginning of what should be a multi-pronged effort to improve patient outcomes, optimize the return on EHR investment, and strengthen care team-patient relationships. However, this decision should not be taken lightly and requires significant investment to do well. A host extending an EHR to another healthcare organization is taking on a significant responsibility; they are, in essence, becoming a vendor. The affiliate organization relies on them, and the host organization must recognize the weight of this responsibility. Agreeing on clear program scope and service level agreements (SLAs) is important to a mutually beneficial and long-lasting host-affiliate relationship. That means updating policy and procedure documentation and creating user workflows that work for both the host and affiliate organization. Additionally, creating functional shared governance between the host and affiliate will allow concerns to be raised and addressed in a meaningful way, continuing to strengthen the partnership.

Affiliate organizations must also understand their part in the relationship. They often underestimate the level of effort required for a successful EHR extension as well as the long-term resources they must provide to ensure success with the system. Organizations may have previously had a locally hosted or home-grown system, where changes could be made quickly as requested by care professionals. Now, system changes will need to be reviewed at a system-level to ensure they will work for the entire user population and are in alignment with organization-wide clinical workflows and documentation standards. Affiliates may feel a loss of autonomy and must be prepared to work through these changes with their host and with their employees.

System adoption is imperative to an EHR extension and is a shared responsibility between host and affiliate. To ensure end-user competency and adoption are maintained, training and ongoing education needs must be proactively evaluated and deployed across the host and affiliate organizations; leveraging a Super User program post-go-live is just one way to drive long-term user adoption. Careful attention needs to be paid to the adoption curve; supplement with education and intervention if adoption declines. A continuous improvement mindset is essential and optimization efforts may be required to capitalize on the EHR’s new or improved features. Gaps in end-user education can be identified by analyzing utilization metrics to determine if additional user support is needed. Finally, satisfaction surveys are a useful tool for gauging affiliate success or bringing awareness to support or education interventions that may be deemed necessary.

With the end goal of increasing data accessibility and the quality of care, successful EHR extensions require rigorous planning and strong, collaborative partnerships between host and affiliate organizations to increase data sharing and create the foundation of trust and confidence that substantially benefits clinicians and patients. Using clinical data aggregated from across the affiliated network yield the most important result: an enhanced user experience and improved clinical outcomes.

Topics: EHR, featured

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