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Universal EHRs

If you've followed us for any amount of time, you'll know EHRs will be a hot topic for the next few years in the healthcare industry, if not here's a starting point. 

Healthcare providers in the United States generally don’t harbor very warm feelings for their electronic health records (EHRs). Efforts from vendors and regulators that are to improve the experience of interacting with these foundational health IT systems have produced poor results with usability issues and fragmented information causing the most frustration.

With that in mind it may be then counterintuitive to suggest that expanding the industry's reliance on EHR's is actually the key to making EHR use less stressful and more useful yet that's exactly what Philips of the 2018 Future Health Index states.

It may seem counterintuitive, therefore, to suggest that expanding the industry’s reliance on EHRs is actually the key to making EHR use less stressful and more useful – but that is exactly what the 2018 Future Health Index, commissioned by Philips, seems to indicate.

“Universal EHR structures, in which every citizen’s electronic health record is connected to a single national system, are tied to higher trust in the healthcare system and higher value for patients, the international assessment showed."

Unified electronic records have also driven national governments to address privacy issues and security with varying degrees of success. Half of the 16 countries in the index have Universal EHRs while the other half have allowed the free market with a mix of regulatory guidance dictate the direction.

Eight countries with Universal EHRs saw an average "value measure" of 47.29 according to the report. The value measure is a combined score of care, patient satisfaction, and an efficiency ratio score. In contrast, countries without Universal EHR coverage, including Brazil, India, Netherlands, Saudi Arabia, South Agrica, Sweden, UK and the US saw an average value measure of 39.67.

Many healthcare professionals as well as patients in Universal EHR countries (Australia, China, France, Germany, Italy, Russia, Singapore and Spain) expressed a significantly higher degree of trust in their health systems as a whole.

“Healthcare professionals and the general population in countries with ‘universal’ EHRs are also more likely to see health system integration as a goal worth pursuing. In Spain, for example, 96 percent of healthcare professionals and 85 percent of the general population believe integration is important, versus 75 percent of healthcare professionals and 70 percent of the general population in the US.”

The interest in integrating EHRs could be prioritized sooner rather than later as it is becoming expected in a number of nationalized systems whilst US patients and professionals are becoming more aware of the functional limitations of the current piecemeal approach to data exchanges.

The report indicated that countries who have a more integrated health system are much more likely to have patients who trust that system than those who have a less positive view of data exchange capabilities. 79% of patients who think their health environment is highly integrated expressed trust in the system compared with just 47% of integration skeptics, indicating previous experiences may have a significant impact on future optimism.

The Lancet published an assessment of health system performance for 195 countries based on data gathered in 2016. Five out of the 8 Universal EHR countries ranked in the top 20 performers internationally. Singapore was ranked at 22. In contrast, only 2 of the Non-Universal EHR countries, Sweden & the Netherlands, placed in the top 20. The US was 29th. 

While there are certainly other social, economic and political reasons for these outcomes, healthcare data and the way it is used to support population health and care quality is undoubtedly a major contributor to value, outcomes and trust. 

“The Future Health Index's latest report shows that the smooth exchange of health information is central to delivering better value in healthcare. By connecting people, data and systems we can create a network that allows information to flow seamlessly across care providers, locations and systems. It is through data that the outcomes that define value are tracked, measured and improved. Yet, health systems around the world are still struggling to collect, organize, analyze and use health data in a meaningful way.”
 Jan Kimpen, Chief Medical Officer for Philips

More cohesive EHR infrastructure might support advanced big data analytics and capabilities with the evolution of artificial intelligence which can help provide more value from the data. All the included Universal EHR countries except China have established policies around data security and protections which have implemented regulations to guide data sharing. Among the 8 countries without Universal EHRs, the extent of legislation is far more mixed.

“While the Netherlands, the UK and the US have comprehensive data protection and sharing policies, such legislation is lacking in Brazil and South Africa, which also have comparatively low Value Measures. Creating clearer frameworks for the use, protection and exchange of data could not only provide a sounder platform for EHRs, but advance digitization in other areas.”

AI is likely to be a beneficiary for more comprehensive data sharing frameworks and providers/patients will subsequently receive value from AI tools. Access to enough high-quality data for training AI models is an ongoing pain point with data sets often locked away in proprietary silos and organizations often reluctant to allow data sharing with in some cases their competition.

Patients are to often wary of how their data is used and shared according to the report. More than half of FHI survey participants ranked their health data as the most sensitive information about themselves, topping concerns about their emails and social media data being exposed during a data breach.

Overcoming the barriers may be crucial for combing robust EHR infrastructure with AI producing value. 

“The 2018 FHI identifies AI as a significant contributor to a healthcare system’s ability to provide data-driven care. Singapore, the country with the highest Value Measure, ranked third for spending on healthcare-related AI for therapy planning.”

Sweden, the United States, and the Netherlands – all countries without a universal approach to EHRs – spend the most per capita on artificial intelligence for diagnostics. Yet, in the US this technology is far from widespread. While organizations are quick to predict AI taking over the healthcare industry within the decade, executives are not moving rapidly to making this a reality.

Close to 2/3 of providers have ranked AI as a low priority in this Connected Medicine poll with many questioning how ROI would be achieved if they did pursue AI.

In a more recent KLAS survey, just 17% of US organizations have adopted AI for clinical decision support around diagnostic imaging. 53% of organizations had no strategy to do so. Once again, there are additional reasons for which AI has not yet found a home in the US healthcare system. But data silos created by basic EHRs and other outdated healthcare systems are likely to slow down the process.

To get ahead of these challenges, the FHI report suggested that provides organizations focus on creating integrated workflows which do not enhance existing irritation with electronic healthcare systems. Collaborating with developers and experts outside of the healthcare industry where user-centered design has already been applied more successfully could help craft a more intuitive and effective workflow.

Senior leadership have actively sought out opinions and education on how to create a data driven culture which prioritizes technical integration, data governance as well as feedback on how to best employ AI and other health IT strategies to produce impactful results.

“It is clear that experts and practitioners from various parts of the healthcare spectrum are virtually united in recognizing the potential of connecting people, data and systems to create a network that allows information to flow seamlessly across care providers, locations and systems. They see how it can address pressing systemic constraints and deliver more effective care, and they are working to advance these technologies both within their own organizations and more broadly. Importantly, there is also a high level of agreement on the steps needed to drive change and make integrated care a more universal reality – and these steps are broadly applicable regardless of the technology or solution in question.”
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