EHR Solutions Pivotal for Transformational Change

Co-authored by John Symon & Mark Edwards

Health authorities across the world in affluent and less affluent regions are in crisis, trying to maintain the level of care they have previously provided to an ever growing and ageing population. Not solving the healthcare problem could have potentially dire repercussions for the population’s health and welfare as well as having a huge impact on local economies. 

A Second Healthcare Paradigm Shift Is Required

150 years ago, healthcare made a significant shift in the way that it delivered  its medicine. The discovery by Joseph Lister, linking the lack of cleanliness in hospitals to deaths after operations, caused a paradigm shift in the way that clinicians prepared for operations and delivered their medicine.  Discoveries also by Louis Pasteur (who discovered germs and worked on vaccines), Alexander Fleming (penicillin) and Edward Jenner (vaccination for smallpox) together had an impact that is still felt today. Currently, Information Technology is having a profound effect that could be just as impactful, transforming the delivery and managing the increasing cost of healthcare.

There are relatively few strategic options available to healthcare organisations worldwide:-  

• Pump more money into systems that are creaking under the pressure. 
• Increase efficiencies in managing systems, assets and processes. 
• Improve the knowledge and quality of the IT system providers who service this industry and provide solutions that are more closely aligned to the true needs of healthcare organisations, via greater understanding of specific clinical requirements. 
• Tackle the problem of care in a totally new way - A more joined up and holistic approach that looks at addressing more of the causes, using data analytics on a massive, inter-governmental scale. 

The reality is that a longer term solution will probably require all of the above - probably on a world healthcare platform.

In the first of our three articles on the healthcare sector, we reported how ECM/IM technologies and solutions are instrumental in addressing the increased pressures faced by governments and healthcare organisations worldwide, to provide a better healthcare service, despite decreasing resources.

In this third article, we look more specifically at the EHR (Electronic Health Records) market and the challenges healthcare organisations face in meeting government mandated deadlines to migrate to fully digitised patient records within the next 2-3 years. 

Electronic Health Records: Step Changes In a Journey towards No Paper

Accenture estimated the global market for Electronic Health Records (EHR) would reach $22.3bn by the end of 2015, with a 5.5% growth each year. The UK is the biggest electronic patient record (EHR) market in Europe, with $2.1bn expected to be spent on the technology over the next two years, prompted by the drive to go paperless by 2018. The US represents the largest market at $9.3bn.

However, as stated by Kaveh Safavi, Global Managing Director of Accenture Health:

 “Although the market for EHR is growing, the ability of healthcare leaders to achieve sustained outcomes and proven returns on their investments, poses a significant challenge to the adoption of electronic health records. As market needs continue to change, we’re beginning to see innovative solutions emerge that can better adapt and scale electronic health records to meet the needs of specific patient populations as well as the business needs of health systems.”

Stopping the Generation of Paper

In the general practice (primary) care market, great strides have been made in EHR systems from booking appointments and prescriptions to taking case notes, making referrals etc. However, in the secondary care (hospital) environment, the reality is that a massive amount of patient records are still held on paper. The cost to digitise every patient record has been prohibitive, with some high profile failures in the past, for example in the UK, towards establishing a national electronic patient record system.  Further, most of the business and clinical processes have been built around a paper based information flow and, even after an EHR installation; some of these processes remain dependent on paper, to some degree.

The first step needs to be to stop generating paper in the first place. Without doing this, the solution to the more efficient management of patient information will be needlessly complicated and costly.  Of utmost importance, going forward is the need to look at the source of each of the data inputs and the collection and conversion from paper to using electronic forms input with multiple input devices and input locations. 

Prioritising this analysis requires a common sense approach to address which paper record is stopped first. Typically, 20% of the forms create 80% of the paper records.  Addressing these first will quickly reduce paper generation and the consequential need for possible paper digitisation. 

Interim HSM Solution

Gaining control of the paper documents, as a first step in the process, will more quickly provide efficiency improvements and a faster ROI.  The reality is that a relatively small percentage of any large patient record libraries require on-line access at any one time, with an estimated 80% of records never looked at again. Less active or inactive paper records can be held off-site or scanned on-demand as required, and integrated into the EHR system. This reduces conversion costs significantly. A good analogy with what to keep on-line or archive is with Hierarchical Storage Management (HSM) systems for data storage, which automatically move data between high-cost and low-cost storage media. The HSM system monitors the way data is used and makes best guesses as to which data can safely be moved to slower, less expensive storage and which data should stay on the faster devices.

Integrated Solutions for a Holistic Healthcare Service

What is needed first is a well thought out, integrated, medical records strategy that addresses the needs of clinicians, staff, hospital administration, external social services and patients.  It is less about the format in which the patient information is held, more about making sure that this information is readily accessible, at the right time, for the key stakeholders. There are modern, location based filing solutions that can minimise lost or misfiled records, providing a practical “hybrid” approach, enabling full migration towards an EHR system once a proper audit has been carried out, prioritising what should be scanned or retained on paper and/or archived off-site. 

Another key factor and driver for the implementation of EHR systems is the growing demand for transformational change within the Healthcare ICT sector.

As stated by Saffron Cordery, Director of Policy and Strategy, NHS Providers in the UK - 

“There is a general acceptance that there are benefits to be reaped from going paperless - but these benefits partly came from the opportunities to change the way things were done when moving to a paperless system as opposed to simply replicating the paper system on a computer. To get buy-in we need to make the clinical case and that is where the challenge will come. This is not just about removing hundreds of filing cabinets but about transforming the way we deliver care.”

In order for clinicians to have a single view of the patient, both electronic and paper documentation must be integrated. This will mean they can instantly see information online but also understand what is still on paper without going in two different directions. This approach could prompt a request to scan a paper record as it becomes relevant to have it online. A further benefit of this approach is that a wholesale transformation project from paper to electronic is no longer required and the business can decide what to scan, and when - based on benefits rather than a prescriptive process and without causing confusion amongst the user base.

The 5C’s - Care, Cost, Co-Ordination, Collation & Compliance

Linked with the migration to the Holy Grail of full Electronic Health Records are a number of key, interconnected areas, present across any healthcare organisation, that need to be addressed:

CARE - The key priority should be on assisting the clinicians to provide a better level of care and work in a way that utilises their skills and knowledge to the maximum. They are the people who have to use the EHR system and need to focus on patient care rather than administrative tasks. Often, too little consideration is given to users - a common problem across many industries, with regard to software and the delivery of IT systems; this appears to have been particularly prevalent in the Healthcare sector. Products therefore, need to be developed that are practical, easy to implement and which meet the specific requirements of the users.

COST - What are the real business benefits that can be achieved from the system? All too often systems are technology led with little thought to the ROI. This does not mean scanning everything but taking a step-by-step approach, as already outlined. The comparative costs needs to be assessed of deep storage for less active records or (short term) onsite storage, against the cost of preparing, indexing and scanning of inactive records. Converting all documents to digital format would have a payback in excess of 30 years, versus 12-18 month with a hybrid approach as previously outlined.

CO-ORDINATION - Any EHR strategy needs to take a comprehensive, integrated approach to the whole patient care pathway, from admission, diagnosis and treatment to discharge, deploying a combination of technologies. Increasingly, this means the utilisation of mobile devices to provide clinicians with the right information at the right time at the point of care in collaboration, in real time, with other medical staff and administrative personnel. Further, there is a growing requirement to link both hospital and social healthcare services, which demands a broader EHR strategy. 

COLLATION - The capture and collation of medical data about the patient is critical to avoid having unconnected silos of information, not just across healthcare departments but on a regional and even international scale.  The journey to this end needs to extend beyond merely the patient record itself to include control of medications, staffing, hospital equipment and all medical assets. This provides a complete picture of the healthcare that is currently being provided and can then be linked to individual patients and their treatment. Such valuable data can be collated and analysed, providing important information for future improvements in the treatment of specific diseases, as well as the more common reasons for tracking, such as compliance, co-ordination and cost reduction.  
In the future, collation of data could extend outside hospital walls, with patients wearing the equivalent of fitness tracker bracelets or bio feedback devices that continually monitor not only vital signs but also patient behaviour and activity levels.  Analysis of this mass or “big” data on a global scale could lead to significant advances in patient healthcare and the treatment of disease. 

COMPLIANCE - Any system needs to address data privacy issues and safeguard against misplaced or incorrect patient information that could lead to malpractice and possible litigation. It is also not just about tracking and managing patient records but all hospital assets, including drugs, supplies and equipment and their usage.

The GS-1 Factor; a Global Traceability Standard

In moving in the direction of a single tracking system, there is an initiative to standardise on the GS-1 coding system, which holds the identification keys and is designed to ensure auditability and traceability of everything related to the patient.  With GS-1, every single device, supply, asset and person in a hospital needs to be tracked and managed, using the unique data held against them, such as the history of usage, date of maintenance or use by date, and supplier.  This unique identification of every event, product and asset across an entire healthcare organisation, is helping improve efficiency, clinical performance, the patient experience, care and safety, and should be part of the overall healthcare record.  

This is a big but achievable task that embraces technology to provide seamless healthcare provision, centred on patient needs. By using unique identification standards everywhere along the patient pathway, it is possible to increase efficiency and create a mechanism for data collection that can subsequently be used for clinical studies and the improvement of care pathways, medications and treatments. This also ensures greater accountability and compliance and a reduction of waste of expensive medical supplies and equipment.

The Impact for EHR vendors

• With a plethora of EHR players providing, either on-premise, Cloud or Open Source EHR solutions, there is a scramble by vendors to differentiate their solutions in an increasingly crowded market.
• There are now significant funds, made available by governments worldwide, to focus on achieving full migration to electronic health records - especially in the US and the UK.  

For example, NHS organisations in the UK now have access to £1 billion in capital funding and £400 million in revenue to help them become paperless over the next five years. This follows Health Secretary, Jeremy Hunt’s latest announcement, that the government will be investing £4.2 billion in NHS technology over the next five years, which includes £1.8 billion for achieving a paperless NHS by 2020.

• There is a growing need for vendors to design systems that are relevant for the user, with practical benefits and a compelling ROI, rather than a top down, one size fits all approach. This is giving rise to a new set of innovative vendors that are now beginning to have an impact on this market.
• Increasingly EHR systems need to integrate within the broader Healthcare IT spectrum, linking clinicians, medical staff, hospital administration and external social services to provide a more holistic view of the patient care pathway. 
• Systems need to be able to capture, analyse and manage all relevant patient data which can aid in future research and treatment of medical disorders. Further, the correct coding of patient treatment can streamline billing and cost recovery solutions.
• The tracking and management of all hospital medical supplies & equipment, as well as staff, can drive increased efficiencies, reduce costs and ensure greater compliance. It is also an integral part in the care of every patient and their care record.
• Despite the drive to achieve full electronic health records over the next 5 years, the reality is likely to be that there will be a proportion of legacy patient records held on paper that will need to be managed for a much longer period.

The Healthcare ITC sector, particularly for enterprise software and data management solutions, is experiencing considerable M&A activity.  This is a hot sector of the market, driven by strong global user demand, technology disruption, government funding initiatives and an increasingly competitive landscape. 

We are seeing consistently more acquisitions in the healthcare sector over the last 18 months than any other, with solid multiples of 2.5-3x revenues and over 13x EBITDA. 

We expect that this sector will continue to dominate the spotlight for the next 10+ years. It will take that long for the impact of technology change to transform the improvements and benefits required by clinicians, staff, patients and administrative services of healthcare organisations, worldwide.  

The window of opportunity is wide open for vendors in this sector

Related articles:

ECM/IM Technologies Help Stretch Healthcare Budgets
The Healthcare Sector Continues to Sizzle for Switched On Software Tech Vendors

Co-authored by John Symon & Mark Edwards
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