Unified EHR strategy tied to increased delivery of evidence-based care

Implementing a unified, single-source electronic health record (EHR) technology is tied to the more frequent delivery of evidence-based patient care, says a new study from the University of Notre Dame published in Decision Sciences.

While the news might not be all too surprising to CIOs or frontline clinicians, the study confirms that an overabundance of moving pieces within an organization’s a health IT infrastructure has a negative effect on interoperability, access to meaningful insights, and the ability to deliver the best possible care to patients.

“We find that the sourcing strategy employed for EMR systems impacts conformance quality, which is a critical measure of performance within hospitals that assesses how frequently hospitals comply with evidence-based practices of care,” said Kaitlin Wowak, associate professor at the Notre Dame Mendoza College of Business.

“Our study contributes much-needed insight into the performance implications of an organization’s sourcing strategy for multi-component software systems, which are increasingly prevalent in modern organizations. We show that how, not just if, EMRs are implemented is consequential to the quality of patient care provided.”

The team used data from hospitals operating continuously between 2006 and 2013, a formative period in healthcare’s digital revolution.

“During the timeframe of our study, U.S. hospitals admitted approximately 35 million patients per year,” said co-author Ken Kelley, Senior Associate Dean for Faculty and Research, and Edward F. Sorin Society Professor of IT, Analytics, and Operations. “All else being equal, if hospitals moved slightly closer to single-sourcing in a given year, say 0.5 units, approximately 175,000 more patients per year would have received evidence-based care.”

However, the positive effect of single sourcing diminished over time, the researchers found, indicating that technology sourcing alone is not the sole defining factor of quality care delivery.  Instead, the organizational culture and vision for EHR utilization may impact the success of either a single sourcing or multiple sourcing strategy.

Unified EHR as part of a balanced, custom solution

For example, a large health system using a unified EHR may quickly find that a one-size-fits-all approach is technically good for interoperability but doesn’t work to meet the unique needs of specific care delivery segments.

On the other extreme, adopting highly individualistic systems to meet the requests of every unit stakeholder will result in highly fragmented infrastructure that creates data siloes and fails to serve patients in an optimal manner.

The key is to balance overarching interoperability needs with customized workflows for disparate components of the health system.

Organizations must develop a tailored roadmap for choosing and implementing the right health IT components and invest in ongoing training, EHR optimization, and provider-level performance monitoring to ensure that care providers are adhering to guidelines and leveraging technology tools, like clinical decision support, in an appropriate manner.

“We find that context matters,” the study says.  “It is not where the hospital starts, but brother, how it changes, that is key.  Hospitals have less control over their sourcing starting position, but they completely control their sourcing approach over time.”

The study notes that EHRs are currently evolving into “platforms” or “hubs” where third-party applications can slot into existing infrastructure using widely accepted technical standards, application programming interfaces (APIs), and other strategies.

This approach, along with changing financial incentives and newer initiatives designed to enhance interoperability, is likely to ease some of the friction present in the earlier days of health IT development and sustain the delivery of evidence-based care at scale.

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry. Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.