Visualization in the operating room relies on the ability to interconnect, and electronic medical records (EMRs) have become the central hub for surgical teams to access patient information. These systems – similar to email and scheduling programs – were originally launched in the 1970s to make communication more efficient. They have evolved to be “central nervous systems” for healthcare facilities.
That’s how Phil Lindemann, vice president of perioperative applications at Epic, describes EMR capabilities in today’s hospitals. Ideally, EMRs will act as central data sources on patients, providing medical history, test results and other important information, in addition to case information, like the implants, prescriptions and processes used before, during and after surgery. Lindemann explains as more programs come online, the easier for facilities to manage inventory, improve outcomes and track performance. Data once only found in paper patient files can be accessed electronically in the OR and command stations during surgery, on patients’ mobile devices before and after to improve engagement, in the facility where the procedure is being performed and throughout the network.
The past decade of innovation is pushing IT departments and suppliers to ask what is next. Surgical teams, some more than others, are excited to see how it will impact patient outcomes. Experts predict two major shifts:
- More strategic mobile access to patient information for surgical teams and patients
- Development of a ‘population health’ approach, based on patient record analytics
“That is an impressive thing that a few years ago would be fantasy.”
As is often the case, the consumer market led the move to mobile devices, and healthcare took a couple years to catch up. Now that some facilities have implemented use of tablets and smartphones, a slew of challenges appeared.
Patients reported feeling less prioritized with clinicians focused on computer screens instead of on their health. Department directors, including in the OR, found unfocused staff checking personal devices. Health Insurance Portability and Accountability Act (HIPAA) issues increased as patients and their information have been jeopardized through online posts or image sharing apps. As a result, hospital policy has been tweaked to use technology more strategically. For instance, instead of updating charts on a desktop monitor, which makes patients feel less involved, hospitals have started using tablets. These tablets can be used to share imaging results during a consultation, video clips while reviewing their surgery and other previously inaccessible feeds.
Lindemann says mobile EMR technology is no longer limited to facilities as more patients start using mobile health apps. “A patient who is in charge of their own health and is knowledgeable about their own health is going to do a better job at taking care of themselves,” he explained. One way to increase this patient engagement is through mobile-friendly patient portals. These portals are usually linked to EMRs to alert patients of upcoming appointments, medication reminders and provide easy access to their data. “That is an impressive thing that a few years ago would be fantasy,” Lindemann noted. Early adopters are already using technology to make suggestions, and he thinks the EMR and internet of things, commonly referred to as IoT, will drive more than just automated mobile updates – possibly tracking patient movement in a facility and spurring OR automation. “These things exist, but we are going to see more and more of them.”
‘Evidence-based practices’ has been a key term in healthcare, especially as reimbursement strategies changed. While this currently means doing research on different techniques and tools, EMR analytics take this one more step forward by tracking patients’ procedure preparation, case details, rehab and potential readmissions in various settings, both in internal and external facilities. “You will see more and more analytics driving decisions, so it is not just gut, hearsay and soft subjective things. We are going to show people the data so they can make decisions,” Lindemann said.
Current systems look at a combination of these factors to help surgical teams assess their performance hoping to improve the amount the facility is reimbursed. The challenge for facilities is to manage factors that cannot be consistently measured, Lindemann said; tracking all of this and offering objective data to surgical teams will help them improve their practice. Eventually, he thinks this technology will start making suggestions to surgical teams, based on previous case data, as to what materials should be used during surgery or how rehabilitation should be structured.
The challenge is not all EMR systems are set up for this system-wide review. That is where OR workflow software and analytic companies, like LiveData, come in. “Facilities have spent a lot of time and money on essential infrastructure, with some good initial benefits. However, the great outcomes expected are absent unless you augment your infrastructure with a workflow automation solution,” Jeff Robbins, president and CEO of LiveData, said. “Now is the time to functionalize the data to drive real-time improvement in outcomes, quality, access, and utilization while driving down healthcare costs. This is what our customers are searching for.” Software like LiveData’s can be used in conjunction with an EMR to coordinate teams, automate documentation, predict staff and patient needs and provide consistent, fine-grained data to produce performance-based data and reports.
“Software must work. It sounds crazy to say, but there is a lot of stuff out there that just plain does not work. That leads to those change problems.”
The biggest issue behind technology changes in healthcare is a lack of clinical acceptance. Lindemann says when new software, including EMRs, were introduced, they were not as user friendly and sometimes poorly structured. “Software must work. It sounds crazy to say, but there is a lot of stuff out there that just plain does not work. That leads to those change problems,” he said. “No IT project is just an IT project. These are all change management and organizational projects.”
The driving force for some integration was the EMR Meaningful Use initiative. Started in 2011, the third and final goal should roll out in 2016. The specifications are still under review, but Lindemann and Anju Mathew, of McKesson Medical-Surgical, say since the requirement to adopt EMRs has already passed, and no new technology is required, surgical teams should not notice any big changes. If anything, they will notice the effectiveness of stage 1 and 2’s rollouts, which put a focus on data capture and sharing and advance clinical processes, they said.
Despite the previous idea ambulatory surgery centers needed to comply with meaningful use guidelines or receive penalties, about six months ago the Centers for Medicare and Medicaid Services (CMS) clarified the centers have been left out of this initiative. Last year’s struggle toward compliance resulted in most surgery centers implementing EMR systems, and Mathew said it made these smaller facilities aware that EMRs were not just a medical record. It includes scheduling programs, patient engagement solutions, supply chain management and connectivity to images, videos, vitals, patient history and case information. The biggest benefit they see is how easy it makes billing and managing the patient’s overall care, she said.