By John Palmer
Editor’s note: The following Q&A resulted from a conversation PSQH had with Doug Cusick, CEO of TransformativeMed, a Seattle-based electronic health record (EHR) provider and consultancy.
In this discussion, Cusick talks about why it has taken EHRs so long to roll out their technology virtually and why it took a pandemic to make EHRs—and health systems that use them—more accessible and easier to use.
PSQH: What do you think are the greatest benefits to implementing an EHR system virtually? What exactly would a virtual system look like, and what are some of the biggest infrastructure upgrades that would be needed?
Doug Cusick: The greatest benefit to a virtual EHR implementation is the cost savings to an organization.
Consider a scenario where an organization can sign up for an EHR service via a website, provide some basic information about the organization and its users, and then immediately begin using the software after some basic tutorials. This is a low-impact, low-cost alternative to traditional “go-lives” that, at most, might require some local computer upgrades to have increased memory capacity. A virtual or cloud-based EHR should require no significant infrastructure upgrades for the purchasing organization due to the very nature of the EHR being virtual. Likewise, “plug-and-play” or app-based technologies are also now available to make EHRs function more efficiently, and many allow for quick installation, configuration, and deployment.
From a software company’s perspective, the biggest challenge in providing virtual or cloud-based EHR solutions is the ability to make configurations quick and easy through the design and implementation of clinical best practice workflows, reducing the complexity of system functionality and designing a system that is so intuitive that it requires minimal user training. The infrastructure and experience needed to accomplish this is immense, as a virtual EHR requires substantial data storage capacity, security to protect protected health information (PHI), and outside connectivity technologies to share information with other EHR systems (e.g., with departments of health).
PSQH: In this world of COVID-19, what can a virtual EHR do to improve patient safety and potentially save lives?
Cusick: A virtual EHR removes physical location as a barrier to providing care and information-sharing—making it safer for providers to deliver care and supporting technologies such as telehealth that reduce patients’ potential exposure to COVID-19. It enables provider groups and hospitals to bring more minds to the table for deliberation, decision-making, and information-sharing, and also minimizes the care team’s exposure to COVID-19.
As we’ve seen during the pandemic, keeping frontline workers safe and healthy has never been more paramount. Enabling remote medical consultations between the provider and an ambulatory patient, as well as practicing telemedicine from home, minimizes exposure to COVID-19 and other infectious diseases, reducing the chances of exposing and infecting otherwise healthy patients.
Virtual information sharing can be critical in the context of patient safety in the face of new viruses. For example, remote medical consultations and real-time information sharing between providers in a health system with a shared EHR—or between departments such as the MICU and Infectious Disease—can cut down on safety misses and adverse events that could potentially harm patients.
Specific to the hospital workforce, with the right technology integrations, care teams can work remotely or semi-remotely and maintain a physical distance, helping to prevent the potential spread of COVID-19.
PSQH: Many hospitals have already invested lots of capital into EHR systems. What are some incentives for getting them to go virtual, and how do existing systems integrate with a new virtual system?
Cusick: Extensive adoption of electronic communication options (virtual meetings, remote systems access, high-speed internet) makes moving to a virtual system more logical than ever and reduces barriers to getting support when needed. With virtual implementations, design and training sessions can take place with end users without needing to schedule a physical space. And there are options for information dissemination, such as electronically delivering premade videos, live webcasts, and social media.
Other incentives for the organization to use virtual implementations to upgrade their existing systems are the overall reduced costs. There is less physical space needed for on-site employees, and reduced implementation and support time as the virtual work provides for more flexibility for getting work done outside of the traditional workday.
With virtual systems, there can be increased clinician satisfaction because there’s an increased flexibility to meet with clinical users on their schedule without interrupting workflow. And there are other aspects that increase satisfaction, such as 24/7/365 technical and clinical support without delay for travel to and from different physical locations.
Keeping clinician satisfaction in mind—and helping them with their workflows rather than impeding them—results in more productive physicians who are more satisfied. With that comes greater—and safer—patient throughput. There is also a significant opportunity to reduce the burden on the health systems’ IT support centers and the CIO [chief information officer] because the vendor partner takes on more of the traditional roles that link the IT department with the clinical users. This reduces the frustration and need for the CIO and IT support to juggle and manage so many requests coming from the users and enables “wins” to be delivered quickly and with more success.
PSQH: What are some examples of healthcare organizations that have used a virtual EHR, and what outcomes have they seen?
Cusick: It’s only recently that any health system has implemented a full EHR virtually, with the most recent being a Cerner implementation at Macon Community Hospital in Lafayette, Tennessee. The healthcare industry typically has not implemented EHRs remotely due to the vast undertaking needed. However, a small number of software companies recognized years ago that available technology could enable remote implementation of “out-of-the-box,” already customized clinical workflow solutions, such as those that enhance EHRs, with little to no training required as long as the solutions are designed to be naturally adopted at “go-live.” It is also critical that these application vendors not be an IT burden on the organization, especially for the IT decision-makers responsible for the vendor selection. The value expected from the health system should be realized right away, with quick wins that increase clinical quality and provider satisfaction.
PSQH: What do you foresee as the future of virtual EHR? Will patient information, for example, live in the cloud instead of in file cabinets in the future? How will a virtual EHR protect sensitive patient information?
Cusick: The future is already here as very few healthcare providers in the United States use paper medical records. Medicare reduces reimbursements to providers who do not use EHRs, so many have converted to EHRs either by purchasing and implementing large, expensive systems or by joining larger healthcare organizations and adopting their EHR systems—or by using one of the many smaller, cloud-based systems that provide end-to-end patient-provider engagement through portals to access records, schedule appointments with providers, and perform medical billing.
EHRs by their nature are designed to protect and keep patient data private and confidential. Because technologies such as APIs communicate back and forth with the EHR where the data resides, it remains protected.
John Palmer is a freelance writer who has covered healthcare safety for numerous publications. Palmer can be reached at firstname.lastname@example.org.