Improving compliance with EHR priorities in an era of decentralized hospital-based healthcare

Hospital mergers and acquisitions can create challenges integrating different electronic health records (EHR) systems
As healthcare decision makers well know, the industry is experiencing unprecedented challenges on numerous fronts. Declining reimbursements, new federal regulations and incentives, an increase in insured patients, and evolving consumer expectations are requiring hospitals and health systems to rapidly adjust how they approach and deliver patient services.
These market dynamics are in part contributing to a resurgence of hospital acquisitions of and mergers with outpatient specialty centers and private practices. Decentralizing lower-acuity care into community settings has the potential to deliver wins from multiple angles. Hospitals can develop down-stream revenue sources while creating a broader referral base; they improve their ability to manage overall patient outcomes, in line with the shift to population-based care; and they can extend their brand and market share while reducing the risks that come with providing care in an inpatient setting.
As the Health Facilities Management/American Society for Healthcare Engineering 2015 Hospital Construction Survey¹ found, nearly 24 percent of respondents noted they are considering health system-branded general medicine and family care centers in the community, and 22 percent are considering ambulatory surgery centers, in response to reduced reimbursement rates and new payment arrangements.
Even with their potential to right the ship, mergers and acquisitions present their own level of challenges, not least of which is integrating different electronic health records (EHR) systems and processes. Any shift of this magnitude will require accompanying operational and cultural changes. So what is the key to improving system-wide EHR compliance and efficiency? Improving how the technology is accessed by caregivers. Understanding how technology mounting solutions can support the goals that are driving healthcare acquisitions will help hospitals and health systems mitigate some of the challenges ahead.

Trends in the market

For hospitals, there is an attractive market in decentralized services. Acquiring or merging with community-based physician groups and specialty centers increases hospitals’ reach with more convenient, community-based anchors. Theoretically, revenues are less dependent on admittance rates; now hospitals can harness revenues from more routine and specialty care cases. Bringing more physicians into the fold also expands referral networks.
Treating routine and non-acute care in community-based centers—whether a physician practice, urgent care center, an ambulatory surgery center, or a specialty care center—also lessens costly risks related to readmissions or hospital-acquired infections.
The move also anticipates the challenges of managing the health of overall patient populations as the country shifts to value-based care. Bringing providers across specialties into one network improves the ability to oversee a patient’s full continuum of care—and provides greater insight into data analytics. A well-managed network supported by a smart IT backbone has the potential to influence patient outcomes while driving inefficiencies out of the system.
For physicians, too, there are benefits. The opportunity to forgo the administrative hassle and costs of upgrading systems and processes to support new federal mandates is a powerful draw. With a robust EHR system behind them, physicians can significantly improve patient health and meet patient expectations by tapping into a larger trove of patient data than they could maintain on their own.
But for every merger or acquisition, hospitals take on greater risk and financial cost, and not just that related to physician compensation packages and additional square footage. Hospitals also assume all IT-related costs and maintenance. Hospitals may find they need to install new or upgrade existing EHR systems, as well as maintain those systems. And with that comes the potential for organizational change, particularly as hospitals acquire practices that have entrenched EHR practices or, in some cases, no EHR system at all.

Streamlining EHR across the system

Between federal government incentives and mandates, the desire to improve overall efficiency and big data insight, and patient expectations for information access, EHR adoption has rapidly increased across hospitals, health systems, and independent practices alike. But this may offer a mixed bag for hospitals as they grapple with integrating different systems under their umbrella.
EHR adoption rates up across the board
According to the Office of the National Coordinator for Health Information Technology (ONC), as of 2014, a majority of office-based physicians were using EHR systems, and nearly 75 percent of these physicians were using a certified EHR system (meaning the EHR met Meaningful Use criteria). Primary care physicians have the highest rate of adoption over medical and surgical specialties, but the level of EHR functionality varies.²
The ONC has found that hospitals, too, have increased not just their adoption rate, but how they share that information with patients. As of 2014, more than six out of ten (64 percent) of non-federal acute care hospitals allow patients to view, download and transmit their health information electronically.³
All of which goes to show that, while adoption rates are up, the systems used and how they are used range across the spectrum. For hospitals looking to fold specialty centers and private practices into their brand, this could pose an interesting challenge. Their new partners likely have embraced EHR, but caregivers may need to adjust to a new system to conform to hospital standards. In this case, ensuring that standardized, easy and intuitive computer mounting solutions are in place to facilitate caregiver access to the EHR is imperative.
HCAHPS and caregiver interaction
The advent of Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS) adds yet another dimension to the issue. HCAHPS puts hospitals under enormous pressure to demonstrate that patient engagement and satisfaction are a top priority, which should influence how technology is accessed in the patient room.
Patient satisfaction is driven by multiple factors, including the level of care patients believe they are receiving. Nursing staff who spend more time in a patient’s room can affect this perception of care. Enabling nursing staff to interact face-to-face with patients while charting in the patient’s room—-and even allowing patients to view their own chart—-promotes patient engagement. It also offers the added benefit of allowing nursing staff to complete their charting with fewer interruptions and distractions. As hospitals decentralize care, the need to provide for this level of patient engagement downstream is compounded.
And hospitals are taking note. According to the Health Facilities Management/American Society for Healthcare Engineering 2015 Hospital Construction Survey, nearly 20 percent of respondents said they are decentralizing support services to refocus point of care in the patient room and increase the number of services at the bedside.⁴
Ensuring computers are in place at bedside to enhance patient and caregiver interaction is paramount. Computer mounting solutions that allow for face-to-face interaction, protect patient privacy and are intuitive to use will play a key role in successfully transitioning more services to the patient’s side, whether it’s an inpatient room or an exam room.
Mining and analyzing EHR data improves patient care and health outcomes
Hospitals and health systems that are using their EHR systems to the fullest extent have access to a valuable collection of patient data. According to a 2015 healthcare analytics survey by CDW Healthcare, hospitals that are implementing analytics are experiencing more clinical benefits than operational benefits to date. Eighty-two percent of the survey’s respondents reported improved patient care, 63 percent reported reduced readmission rates, and 62 percent reported improved overall health outcomes.⁵
The ability to combine inpatient and outpatient analytics will provide hospitals with a tremendous advantage in improving the full continuum of care. Of course, the ability to fully mine analytics is dependent on ensuring consistency across the board in how information is entered into the EHR system. Standardized computer mounting locations that support caregiver workflow will enhance data collection efforts.
Consumers want greater access to information
The demand to use EHR systems isn’t just coming from federal requirements. In a digital age when consumers customize their every experience online, patients increasingly expect to not just view but to also interact with their medical information.
According to Accenture’s 2013 Consumer Survey on Patient Engagement, four out of five consumers say that accessing medical records electronically is at least somewhat important—with nearly half saying it is very important. And, more telling, 41 percent of consumers without online access to their medical records would consider switching to a provider that offers access.⁶
Meeting these expectations is only possible if caregivers across the system are using the EHR system appropriately. Ensuring they have easy access will enhance compliance.
Challenges to integrating IT solutions into existing space
While there are numerous benefits to standardizing IT across the healthcare system, doing so is not without its challenges.
Hospitals may find that their acquisitions use an EHR system that is not compatible with the hospital’s system. They may find that the practices employ processes that conflict with the hospital’s standards for security, privacy and safety. Or they may find that they need to start from scratch as they acquire practices that still rely on paper charting.
All of these factors will require caregiver education, a possible change in operations and a shift in culture. Hospitals, too, will now be responsible for the cost of maintaining equipment in sometimes far-flung reaches of their service area.
In tandem, hospitals may find that their IT solutions are challenged by existing infrastructure and space. Building a new facility provides the luxury of planning for the integration of IT into patient care; acquiring existing space may require creative solutions for working within exam rooms, operating rooms, pre- and post-op areas, and even nursing stations that were never designed to accommodate IT as part of the continuum of care.
Above all, hospitals need to ensure the solutions they implement—whether in their inpatient or outpatient environments—uphold standards for caregiver health and wellness, particularly in regard to the increased risk for musculoskeletal disorders (MSD), patient privacy, and infection control.

Improving compliance through smarter mounting solutions for computers and medical devices

When change is ahead, one of the best means to bring everyone on board is to make it easy to adopt the new process. Implementing mounting solutions that support caregiver workflow, safety and security—and that make accessing the technology easy—will improve the chances that caregivers will quickly take to a new system.
However, not all mounting solutions are made equal; some of the considerations below can make or break caregiver acceptance of a new or revised solution. When choosing a mounting solution, consider:
Solutions that support unique department requirements. Different departments have different needs for how technology is used. Smart solutions providers understand these different needs and offer comprehensive choices to support the right solution. A solutions provider that offers onsite assessments at no cost and installation can be an integral partner in choosing the best solutions for each department. Having multiple options also enhances the ability to standardize across multiple locations, which affects not just appearance, but maintenance as well.
Solutions that support ease-of-use and ergonomics. Because multiple caregivers access IT from a point of service in a given day, the mounting solution should be intuitive to use and easy to adjust. Fully adjustable mounts will also allow caregivers of different heights to work in comfort, protecting against MSD injuries. With so much use, the mounting solutions should be durable and easy to replace.
Solutions that support patient/provider interactions. While bedside charting can have a positive influence on patient engagement, some mounting solutions are better at engaging patients than others. For example, mounting arms that reach well into a room allow caregivers to position themselves so they can face patients while charting. Mounts that allow independent rotation of the monitor also allow patients to view their data to verify information and engender trust.
Solutions that protect patient privacy. Unlike laptops or tablets, which are at risk of being misplaced or stolen, mounting arms are securely fastened to the wall or ceiling. As an added benefit, they ensure that caregivers have ready access to the EHR system at the point of care; no more downtime because of an uncharged laptop or a missing cart.
Solutions that save space. Mounting solutions that reach well into a room and stow compactly when not in use free up space for other needs. Unlike carts or desktop computers, they do not take up valuable space in tight quarters.
Solutions that are backed by the manufacturer. Mounting solutions are an investment in patient care. Therefore, it is essential that they work as intended. This doesn’t just mean having a solid warranty; manufacturer support should start well before that, with full installation services and a trial period to ensure the product is the right fit for the location and staff. The warranty should also cover all repairs and service, of particular value to hospitals with networks that extend over a broad service area.

Supporting caregivers to better support outcomes

With market dynamics in flux for the foreseeable future, hospitals will continue to be challenged to fulfill their missions while maintaining profitability. Efforts to expand market share and improve population health through acquisitions and mergers could offer a sustainable way forward for many hospitals. Of course, with acquisitions comes a raft of challenges, including ensuring that caregivers adjust to and fully embrace the hospital’s EHR systems and priorities. By improving caregiver access at the intersection of IT and healthcare, hospitals and systems will go far in removing at least one challenge to a fully integrated future.
Citations
1. Vesely, Rebecca and Hoppszallern, Suzanna. “Hospital Construction Survey Results are In.” Health Facilities Management. Posted February 4, 2015. Web. September 25, 2015.
2. Heisey-Grove, Dawn and Patel, Vaishali. “Any, Certified, and Basic: Quantifying EHR Adoption through 2014. The Office of the National Coordinator for Health Information Technology. September 2015. Web. September 29, 2015.
3. Charles, Dustin; Gabriel, Meghan; and Henry, JaWanna. “Electronic Capabilities for Patient Engagement among U.S. non-Federal Acute Care Hospitals: 2012-2014.” The Office of the National Coordinator for Health Information Technology. October 2015. Web. October 5, 2015.
4. Vesely, Rebecca and Hoppszallern, Suzanna. “Hospital Construction Survey Results are In.” Health Facilities Management. Posted February 4, 2015. Web. September 25, 2015.
5. “CDW Healthcare’s Analytics in Healthcare. CDWNewsroom.com.” ND. Web. September 24, 2015.
6. Accenture Consumer Patient Engagement Survey US Report