Electronic Health Record systems (EHRs) are a major catalyst for growth and advancement in most aspects of healthcare today but EHRs come with their own unique set of potential pitfalls. EHR use variability, rushed implementations, and a lack of EHR interoperability often highlight how EHRs have pitfalls that often demonstrate or lead to gaps in care.
The variability in the ways in which EHRs are used can lead to gaps in care. From inpatient to outpatient care, utilizing a common workflow amongst staff members is essential for quality care coordination. EHRs typically have instructions or white paper documentation on how to document for specific value-based care measures. However, these workflows may not be followed by all staff members. The larger the health system, the higher the likelihood of multiple [often inconsistent] workflows. Some providers will only use free-text fields to add notes from an encounter. Some may document the same information in one of many different EHR fields. Some providers may be untrained on how to check all available data points to confirm if care gaps exist. These are just a few ways that providers can differ in the way they enter and use information in the EHR, which often lead to costly patient gaps in care.
In addition to a lack of standard workflows, the EHR implementation itself can lead to gaps in care. Rushed implementation can stem from lack of funding, lack of interoperability, and even from concern about physicians and lack of interoperability. A health system having the funds to invest in training, support and the physical infrastructure is a common barrier for small practices and even some larger practices when implementing an EHR. It is important to have the time and funding laid out beforehand to ensure a complete implementation for sustainable usability. All too often, organizations decide on a go-live date where, the old system access is terminated but not all data is merged correctly, staff hasn’t had adequate training on the new product, or specialty-specific implementation requirements aren’t met due to a lack of time or funding. The health system will come up with a “Plan” to continue to implement additional functionality or migrate additional systems, however we see this continue to move down the priority list if not completed during the initial implementation.
Lack of integration leads to gaps in care. Today, many healthcare organizations work to support patients after a health event with mental health counselors or housing specialists. Food and safe living space are major problems today. Prior and current care must be shared amongst the entire care team, including the mental health counselors. Typically, outside of a healthcare or hospital setting there is not access to an EHR. The result is snail mail, e-mails, paper documentation or even complete missed communication. These issues all impact care and lead to gaps.
Even when a patient is seen outside of their primary provider office or healthcare system, it is likely the external practice does not use the same EHR. Medical records are transferred as electronic pdfs or by paper. How are EHRs streamlining patient data when they can’t talk to each other? This all too common issue creates a disruption in efficient data sharing and while clinicians work to regather patient history often invasive tests are re-performed and medical decisions are not based on complete information.
Most gaps in care are related to a lack of standard workflow or lack of transferred health information. Practices need to take the time after implementation to identify and train staff on standard workflows. Practices should utilize their EHR vendor for support in adding additional fields when required or pertaining to a specialty, and making certain fields required to be completed so that they cannot be missed. Data dictionary’s that allow for drop down and pre-populated fields versus free text are essential in standardizing workflows and allowing for the ability to pull and analyze data. More importantly, the communication between integrated systems needs to be improved.