Top challenges managing electronic health records

Bruce Orcutt , President Product Marketing and Management ABBYY
Written by: Bruce Orcutt

A recent study by the American Health Information Management Association (AHIMA) about health information management (HIM) professional career trends attributes the electronic health record (EHR) as a major catalyst for the way health information is managed. In fact, a majority of physicians, 89.6 percent, are using some type of electronic medical record (EMR) or EHR system according to the Centers for Disease Control and Prevention, and nearly 97 percent of hospitals are using a certified EHR system, reports the Office of National Coordinator for Health IT. This has greatly impacted the roles and duties of healthcare professionals, resulting in the need to train future HIM professionals in new educational competencies that align with evolving career opportunities. The AHIMA study shows that HIM professionals will spend a lower amount of time on diagnosis and procedural coding and more emphasis on leadership, teaching and informatics/analytics. To address this trend, AHIMA is proactively aligning its strategic objectives to support emerging roles in informatics and analytics, however, there are still challenges with EHRs and patient forms that will keep HIM professionals stagnant in their roles if not addressed.

Using decade-old technology.

The HITECH Act passed in 2009 when health IT adoption was in its nascent stages, yet, despite claims that healthcare is becoming fully electronic, it’s impossible to completely eliminate paper from patient care. Patients present insurance cards and driver licenses that must be copied, sign forms and provide summaries and referrals from other providers. They also complete health histories and other intake documents. Causing a significant drag on EHR systems is legacy optical character recognition (OCR) data capture technology that is nearly a decade old. While it is able to automate most data entry by digitally capturing and converting the data into EHRs, it is still error-prone and cannot capture unstructured data from various sources, or evolve to new form types or add form fields easily.

Today, there are quality issues that affect speed and accuracy that is putting a drag on efficiency and putting the burden on HIM professionals to manually proof, correct and manage process workflows instead of focusing on patient care.

Doing more with less.

In some medical facilities, the population ratio is one doctor for every 500 people, and the administrative ratio is often greater than the doctor ratio. Yet, the goal for all healthcare organizations is to have staff focus on patient care, not paper work.

To support the rampant use of EHRs, administrative staff and EHR vendors are managing the electronic health records for thousands of providers who are delivering care to millions of patients. For example, athenahealth cloud-based EHR enables over 85,000 providers to deliver better care to more than 83 million patients and converts over four million faxed patient documents to EHRs every week.

“We handle the healthcare record workflow for providers,” said Alison Lo, senior developer at athenahealth. “Our cloud-based EHR receives clinical documents via fax, automatically recognizes and converts them into EHRs, populates the medical records and then takes over the entire workflow, routing relevant information to the right people.”

Health IT systems enable healthcare providers to improve care without hiring additional administrative, whether they’re automating the patient onboarding process, providing process insight to patient workflows in the emergency room or using big data and artificial intelligence to identify diagnosis trends. The foundation enabling these value-add automation processes in intelligent capture which has proven to reduce labor by at least 50 percent while gaining efficiencies anywhere between 30-70 percent. The faster the ability to accurately capture patient data and deliver it to healthcare providers, the sooner they can increase the likelihood of better outcomes.

Increasing complexity of health records.

A greater mix of data is contained within EHRs such as demographic information, medical chart, x-rays, and records featuring text with embedded images. Whether it’s routine, emergency or preventative care, such as breast cancer screenings, healthcare visits still require millions of faxed patient documents to be captured and converted into EHRs every week. The increasing complexity of health records, explanation of benefits and invoices have pushed legacy capture solution to its limits, and exasperated HIM professionals and administrative staff wanting to adopt more outcome-focused models, ensure regulatory compliance and raise patient satisfaction.

To address this growing complexity, athenahealth needed a better solution for recognizing and converting millions of medical document pages a week. “We anticipated big year-on-year increases in the number of faxes and their mix of data,” commented Lo. “We needed a new document capture solution that could handle a wide range of document types with equal accuracy and have tight integration with our systems.”

The complexity of EHRs is one reason why the American Medical Association announced a partnership with the Regenstrief Institute and Indiana University School of Medicine in April to launch an electronic health record training program for medical students – it’s a necessity for medical students entering residency to know how to effectively and efficiently use EHRs. They shouldn’t have to worry whether the data digitally captured is accurate.

Evolving patient expectations.

Patients have become accustomed to a certain level of digital self-service in their day-to-day lives and it has extended to how they expect to be communicated with and engaged with by their healthcare providers.

Consider the patient outreach for preventative care, such as breast cancer screenings. BreastScreen Victoria automated its client centric communications to patients including the invitation for free exams, the ability to make self-service appointments, confirmation and result letters. With the confirmation letter, patients receive a registration form which is pre-populated with personalized patient data. This delivers a more streamlined process for women in completing the form and the screening center in that patients can be processed much faster when women arrive for a screening appointment. Costs relating to paper and postage costs for appointment reminders are eliminated while positive patient engagement was increased.

“Women in our program have embraced the option to be contacted electronically and now enjoy more personalized correspondence,” stated Greg Maudsley, senior project manager at BreastScreen Victoria. “This has realized a project outcome that exceeded expectations.”

Forty percent of women are now opting to receive their appointment confirmation via email realizing a significant hard cost savings. Furthermore, 85 percent of the scanned forms are automatically classified without intervention from administrative staff.

ABBYY, Centers for Disease Control and Prevention, EHR, Electronic Health Records, HITECH Act, Office of National Coordinator for Health IT


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