Specialists Need Custom Approaches To Optimize Electronic Medical Record Systems

Although many health care providers increasingly are adopting electronic medical record (EMR) systems, it is significantly more challenging for specialty providers – e.g., cardiologists, oncologists and ophthalmologists – to find a system that meets their more complex EMR needs.

Currently, roughly 37 percent of hospitals have basic EMR capabilities, which include clinical data repositories, and 25 percent of hospitals have extended those basic capabilities to support automated clinical documentation and clinical decision-making. However, a specialist requires more advanced functionality for an EMR to be a worthwhile investment.

“A traditional EMR relies on reports, images and test results to tell the patient’s medical story,” according to Jim B-Reay, vice president for business development at Healthia Consulting, Ingenix’ provider consulting arm. “A specialist really needs unique features and a more complete narrative for the EMR to be a valuable clinical tool.”

Growing interest in EMRs

Like other industries, during the past decade the health care industry has shown a greater interest in and need for electronic tools that can help automate processes and simplify data management. “Almost every hospital in the country is looking to have improved technology to automate processes,” B-Reay said.

“The EMR, which can facilitate patient billing; provide a full history of lab results, vital signs and history notes; and check drug orders against drugs the patient already is taking, is really gathering momentum among hospital executive teams because it puts the patient at the middle of the system,” he explained. “Until a few years ago, EMRs were helping payment more than they were helping patients, but they have now matured to the point where they can really enhance patient care.”

B-Reay explained that even though more advanced EMR capabilities, such as clinical protocols, closed-loop medication administration and physician documentation, have not achieved significant penetration of the market to date, hospitals and physicians are starting to see their primary benefit: fully integrated care.

“One of the biggest challenges that we have is that the information flowing electronically among the various health care players, such as the hospital, the ER department and the general practitioner, currently is minimal,” he remarked. “By unlocking that information and providing greater access and functionality, patients can get better care when they come into the hospital and will leave with better ongoing care plans.”

Specialists have varied, complex EMR needs

Specialists who want to capture the advantages that EMRs can provide in primary care settings are likely to encounter some hurdles along the way, due to their differing information needs. B-Reay explained that EMRs may capture test results and basic patient data but may not provide the detail that a specialist requires.

“For example, for a cardiac catheterization, a traditional EMR may include a summary report and images, but a cardiologist really wants and needs to review the full account,” he said. “Ideally, the cardiologist could match images with certain points in the narrative.” The tools to make such an interface happen are not available quite yet, he said, “but EMR vendors are starting to understand this information need.”

Other specialists also have needs that are specific to the way they treat patients. Because an oncology visit is a blend of a clinic visit and hospital services, such as chemotherapy or radiation, the standard way an organization might use an EMR for a clinic visit would have to be adapted for oncology to combine the clinic visit component with the hospital service component, according to B-Reay.

Further, ophthalmologists often include images of the eye in their charting, so EMR capabilities need to support either scanning in the drawings or providing these physicians with a simple way to draw on the computer.

Bridging specialist, vendor gaps can be difficult

Specialists wishing to jump into the EMR pool may need some assistance to overcome the obstacles of fitting a square peg onto a round hole. “Right now the situation is frustrating to specialists because they are being asked to participate in EMR efforts that are targeted toward general practice,” B-Reay said. “We need to work on building a system that can truly handle the needs of specialty care, and we need to see a democratization of the data.”

The first challenge, he said, is working with EMR vendors “so they understand some of the specialty distinctions we are hearing on the ground.”  

Healthia Consulting works closely with top EMR vendors in the United States to accurately meet provider needs, help hospitals with system implementation and offer providers consultants on a short- or long-term basis to “get the project done right and within the budget,” he added.

“Healthia wants to make sure that the data are integrated in a smart way, and that our clients are not choosing a quick fix that won’t help in the long run,” he said. “We may be a few years away from some of the necessary tools being available for certain specialties, but we want to help build any system with an eye toward expansion and integration.”

Healthia urges providers to limit the number of tools they are using so they have fewer logins, need less training and get to know one set of tools very well.

In some cases, waiting for new technology to become available may be prudent, B-Reay added. “A cardiologist may want to purchase an expensive system that is tailored to specific practice needs, but if that system cannot be interfaced with any other system, its purchase and implementation is not a strategic move,” he said. “Buying the wrong technology can sometimes be more of a mistake than not buying any at all.”

Healthia can help providers with these decisions and will work to bridge the gap between the provider’s requirements and the vendor’s offerings. Healthia encourages the vendor to create new functions and also will explain to the provider what the EMR’s limitations may be. “We have to be fierce advocates for end users when a tool set is not adequate, and help vendors see where there is still work to do,” he said.

Ultimately we have to build the relationships and partnerships on both sides,” B-Reay concluded. “Clients trust us, rely on our expertise and bring us in to think out loud about a new project. Our consultants often are brought in to do ‘A,’ but within weeks are doing ‘B, ‘C,’ ‘D’ and ‘E’ because they can add value to those activities.”

Healthia’s philosophy is that every one of its consultants has the opportunity to build a one-on-one relationship with their clients and offer something extra, beyond the mandate of the consulting engagement, according to B-Reay.  “It’s something that grows organically out of trust.”

1. HIMSS Analytics™ Database (derived from the Dorenfest IHDS+ Database™) (2008).

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