By Sandra Johnson

For years, healthcare provider organizations have invested billions in time and money on their electronic health records (EHR) systems, pushed forward by federal regulations.

Yet, as our industry continues to be plagued with persistent staffing shortages, clinician burnout, and financial pressures, too often, healthcare organizations aren’t realizing the value from technology investments. Instead, EHRs have made the burden of administrative work so much worse, especially for clinicians. According to a study in the Annals of Internal Medicine, doctors in outpatient settings spend just 27% of their day in face-to-face patient care, while half of their time is consumed by EHRs and desk work. The result is burnout. In a Stanford Medicine poll, 71% of physicians reported that EHRs contribute to burnout, and six out of 10 (59%) think EHRs need a complete overhaul. The level of frustration has led to “Get Rid of Stupid Stuff” initiatives, like the one launched by Hawaii Pacific Health in 2017, which is now spreading to other health systems in the U.S. These initiatives enlist clinicians on the front lines to help identify and eradicate the time-wasting, inefficient, and often unnecessary activities forced upon clinicians by their EHRs.This is one more indicator of the chasm separating the promise and reality of EHRs for making healthcare better for healthcare organizations, their staff and most importantly, their patients. According to a recent KLAS report, one in four healthcare organizations say their vendor does not keep all promises, especially related to support communication and follow-through, product capabilities – in particular integration, implementation, upgrades, development – and ongoing costs. It’s time for disruption in how EHRs are sold, implemented and managed to alleviate IT complexities, eliminate downtime, and lower total cost of ownership, regardless of the size and complexity of the health system.

An emerging system delivery approach

Key concerns organizations express are the upfront costs and unpredictable ongoing costs for their EHR. An alternative delivery model has emerged in recent years: the system-as-a-service (SYaaS) subscription model. The SYaaS model packages everything required to manage the EHR together, including all hardware, software, and ongoing support services, all for a fixed price. This approach centralizes all implementation, integration, optimization, and system monitoring services to manage reliability and performance, while reducing the burden on IT staff.By centralizing key functions and leveraging a modern foundational architecture that prioritizes security and reliability, such as those designed to meet stringent U.S. government security requirements, the SYaaS model can deliver better performance and reliability to eliminate both scheduled and unscheduled downtime. In addition, health systems using a SYaaS model avoid large up-front costs and have predictable ongoing costs, including all current and future interfaces, system enhancements and upgrades, ongoing IT and implementation support, and training and system optimization, which assures return on investment, reduces labor costs and significantly lowers total cost of ownership.

Lean into integration and interoperability standards

While the U.S. government has been instrumental in pushing several initiatives to address the issue, a lack of interoperability persists, from the inability to easily share patient data to suspected data blocking. A recent report from IDCindicated that 40% of clinical leaders identify integration and middleware as infrastructure technologies that have challengedtheir organizations the most, demonstrating the negative impact that fragmented data has on daily workflows and care outcomes.

With a SYaaS approach, health systems can work with vendors that have a proven track record for embracing data sharing and interoperability using standards, such as the Fast Healthcare Interoperability Resources (FHIR) Application Programming Interface (API) as the foundation. For example, a recent report by McKinsey quantifies the potential to free up to 15% of nurses’ time on a typical shift by using technology to automate tasks, such as documenting data from bedside devices, and support better delegation among care teams.

By taking advantage of standard integration protocols, data from a full range of bedside physiological monitors, pumps, ventilators, and any other devices that export data can be automatically integrated within the EHR. Once the data is in the EHR, it’s available for real-time analysis, including predictive scores and scales to identify at-risk patients. Pulling all this data together through integration dramatically reduces charting time, increases accuracy and makes data available to clinicians wherever and whenever it’s needed.

Focus on continuous improvement When it comes to ongoing support, according to KLAS, healthcare organizations often report that problem resolution isn’t what they expected or that they lack access to the support resources they were promised during the sales process. For many, it means that the support package they purchased isn’t sufficient, leading to a feeling of being “nickeled and dimed” for support requests. The SYaaS approach eliminates this issue by factoring all ongoing IT support into the fixed cost, including maintenance, new device integrations, training, and 24/7 end-user support. A benefit of this philosophy is that the vendor must have solid communication and management processes in place to make this approach effective and mutually beneficial. In addition, it creates an incentive to work closely and collaboratively with health system customers to continuously optimize care processes and workflows to achieve improved clinical and financial outcomes. By truly optimizing the system to support efficient processes for all users, organizations see significant return on investment and avoid the need for “Get Rid of Stupid Stuff” campaigns.

Maximize the vast amounts of data contained in EHRs When the EHR is serving its function well, enabling efficient workflows that support rather than detract from patient care, healthcare organizations can put the vast amounts of data gathered to work. The SYaaS approach makes data and analytics a priority as part of ongoing system optimization. Real-time integrated data enables healthcare organizations to thoughtfully reduce manual steps, eliminate redundant charting, and improve workflows. As an example, easy-to-read dashboards that analyze and display real-time patient data and make it readily available anywhere in the hospital – patient rooms, mobile devices, nursing stations, etc., streamline workflows for all clinicians. At the organizational level, the ability to process data and apply advanced analytics provides the insight needed to make data-informed decisions to improve care and operational processes, implement evidence-based standards, enhance patient experience, and improve financial performance.

Disrupting the status quo The time has come for organizations to consider new approaches to their EHR investment that break away from the status quo and prevent the most common broken promises. The SYaaS philosophy addresses today’s challenges from staffing shortages, clinician burnout, and shrinking margins – delivering faster, more tangible value from technology investments. About the author: Sandra Johnson is the senior vice president of client services for CliniComp.

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