Some experts believe that, in order for the transition from paper to electronic records to actually take place in all U.S. facilities, a standard for implementation must be addressed. Could a “lack of uniformity” within U.S. healthcare institutions in regard to EHR implementation be the reason why it’s difficult to attach a precise meaning, and therefore, answer, to the topic in question? Possibly. So, let’s break the issue into more digestible “words,” and think of EHR development in light of a familiar fable – Remember the one about a tortoise and a hare?

A speedy hare brags about how fast he can run. Tired of hearing him boast, a tortoise, challenges him to a race. All the animals in the forest gather to watch. The hare runs down the road for a while and then pauses to rest. He looks back at the tortoise and cries out, “How do you expect to win this race when you are walking along at your slow, slow pace?” The hare stretches himself out alongside the road and falls asleep, thinking, “There is plenty of time to relax.”

Stop the story. The hare says, “There is plenty of time to relax.” What?

Think of the tortoise and the hare as representatives for various U.S. healthcare facilities. Disciplines, facilities, practices – most are in the process of adopting EHR systems but not all are striving toward a similar goal, as there seems to be “plenty of time to relax.” Some institutions mimic the tortoise moving toward an invisible finish line, while others seem to resemble the hare (wandering away and “napping,” so to speak). There are reasons to wake up and act immediately in regard to implementing EHR – reasons that are assumed to increase time, money and accuracy.

Is Hindsight 20/20?

"Catastrophes such as Hurricane Katrina crystallize the need for electronic medical records (EMR),” says George Conklin, who was appointed to the Gulf Cost Health Information Technology Task Force by Rick Perry, the governor of Texas in 2006. “The question wasn’t local . . . it became national,” he says. Members wanted to create and ensure a healthcare delivery system that would enable data exchange between healthcare providers; “A multi-phase plan,” he says, that would: "1) ultimately provide access to drug information on a secured Web site for clinical purposes, 2) a medium – or infrastructure – was created for standardizing patient information, which could serve as the basis for 3) creating a multi-state RHIO [regional health information organization].”  Conklin serves as the senior vice president for Information Management with Texas-based CHRISTUS Health, and he supports CHRISTUS Health’s delivery network in four states, two countries and in more than 300 locations.

Following Hurricane Katrina, Conklin describes the state of thousands of evacuees who were left without medical records and prescription data for their medication needs: "Patients were lying on cots and hooked to IV-bags in the Astrodome,” he says, “without medical records.” Paper-based records are hard to replicate; once they are gone, they may be gone for good. And says, “Physicians were in the awful position of having to infer diagnosis from IV bags hanging on a patient – something everyone found to be unacceptable.”

Barriers of Adoption

EMR solutions and software for healthcare professionals in hospitals and private practices exist, but not all facilities are actively implementing the resources available. A complete transition to EHR among the entire industry has yet to happen. Therefore, the developments of EHR incorporation in local, state and nationwide facilities aren’t happening fast. Why? Many issues impede the evolutionary process toward standardization among disciplines.

“User-ability, user-adoption and interoperability – these are a few of the barriers,” says Mike Wessinger, president and CEO PointClickCare, a provider of Long Term Care software-as-a-service with offices in Minneapolis and Toronto. He says, “User-ability is a barrier for staff that can’t use and adopt to technology, so a need exists for software providers to adopt a consumer-Web look, feel and usability within their applications that is familiar and easy to use, like Facebook, Amazon or Ebay.” The root cause of the second barrier – interoperability – stems from a “lack of accepted standards,” says Wessinger. “There needs to be a standardized solution.”

In the past, there have been, what Wessinger refers to as “pockets of success” in America, when some glimmer of hope for a standardized solution was made evident in practice.  And “these pockets of success will continue,” he says, until there is uniformity. 

As of now, “there are many competing standards for an interoperable health record," Wessinger says. Therefore, a standardized solution on a national level remains a gray area, but is considered a great concern among its experts."Most software providers or vendors are capable of providing an EMR but the difficulty comes when that information has to be shared across the continuum of care and be shared between care settings. A standard for inter-operable health records is what is required to eliminate these silos.”

Wessinger adds, "There are [also] standards organizations and association subgroups that meet throughout the year to address inter-operable health record standards, for example: the Center for Aging Service Technologies, National Association for the Support of Long Term Care, AHIMA [American Health Information Management Association] and HL7, to name a few.”

Communicating Needs

Awareness of what applications work and do not work is key to the process of locating the most optimal solution. Then, communication of the patients’ or clients’ needs within disciplines, in respect to how EHR could improve patient care, also helps to further meet the mandate. Efforts in communication have been escalating – slowly, but evidently showing – through the years. In nutritional therapy, for example, registered dietitians are actively encouraging implementation and management of current electronic systems.

For too long, “registered dietitians and nutritionists have been neglected in the electronic healthcare market,” says Emily Bonham, senior director of product management for RemedyMD, a provider of specialty-specific electronic health records software. The company’s first dietician-focused EHR, DietitianEHR, “meets the needs of registered dietitians and nutritionists.” Healthcare workers that have tried it, talk about its usefulness. 

“For example, they have had to rely upon cumbersome paper documentation that does not allow for outcomes reporting. Yet, generic electronic health record systems don’t fit the registered dietitian’s specific documentation and client-management needs, either,” says Bonham. In addition to benefiting the patient, “going paperless” helps in equipping health professionals to handle the workload of patients more efficiently. 

RemedyMD’s DietitianEHR is a electronic resource that “caters solely to the dietitian’s workflow and requirements, enabling dietitians to better manage their practice, improve outcomes, increase referrals and best meet their clients’ needs.” As one of the vendors who recently promoted EHR solutions at the American Dietetic Association Food & Nutrition Conference and Expo, Bonham encountered participants looking to find software with this kind of capability.

 “Lots of people came up to me at the conference, who said, ‘dietitians are struggling to find EHR in [U.S.] hospitals that suit the dietary needs of [their] clients’.” The electronic adoption process in America has been gradual, but evident in nutrition therapy. For instance, before DietitianEHR, Bonham says, the software was “specific to bariatrics, but lots of dietitians started using it,” which DietitianEHR evolved from RemedyMD’s original EHR platform. “People are inquiring over the Web. Now, we have seen more dietitians using it for weight loss; [customers such as] solo-dietitians, who consult with doctors in private practices – not just dietitians apart of bariatrics” are using the program.

Reaching for the Finish Line

Remember the fable’s ending?

The tortoise walks and walks. He never, ever stops until he comes to the finish line. The animals that are watching cheer so loudly for tortoise, they wake up the hare. The hare stretches and yawns and begins to run again, but it’s too late. The tortoise is over the line. Now, the hare always reminds himself, “Don’t brag about your lightning pace, for the tortoise won the race!” 

Conklin believes that the mandate to transition from paper records to electronic records won’t happen “nationally, but discipline by discipline, and state by state,” he says, “It is sad that  [EHR] is not being driven more globally.” So maybe, national communication of what works and what doesn’t work within disciplines will, in turn, benefit the patient and the organization of healthcare, as a whole, much sooner than if people were silent. So where are we in this  “race,” exactly?

Conklin adds: “the race actually started (or should have started) years ago. No one was there. Now we have a dramatic need . . . we need for society to be safe and healthy. It is time for all the hares and tortoises to get together and build what is necessary to insure a safe and healthy future.”

     - Haley K. Jestice is a staff writer for Therapy Times. Questions ad comments can be directed to hjestice@therapytimes.com.