Overcoming the Challenges of EHR Integration

Stop creating digital versions of your administrative problems

The introduction of electronic health records has been something of a movable feast. For years they’ve been the default software for managing patient information and relationships in the US, and now big firms like Epic and Cerner (recently acquired by Oracle) are ‘going global’ with their sizeable marketing budgets to target net-new healthcare customers. But you can’t digitise your way out of your workflow challenges.

Large health technology companies are pounding the pavements of Europe and the Middle East with multi-million–dollar projects, displacing domestic incumbents and making significant inroads in countries like the UK and the Netherlands. These implementations have become the cornerstone of most healthcare organisations’ digital transformation—or the ‘soup to nuts’ of the patient journey, as our friends from across the pond might say.

The UK Government has made £2bn available to help achieve its target of 90% of NHS trusts having electronic health records (EHR) (or electronic patient records [EPR]) by December 2023. The Government sees the widescale introduction of EHR as a key step in digitising community healthcare records within integrated care systems (ICSs), because it joins up the patient view across all healthcare practitioners.

In this article we explore how trusts can get in on the action while avoiding the pitfalls of trying to digitise away your current analogue workflow headaches. We’ll see the world of possibility that opens up from integrating your EHR implementation with a communications and collaboration platform.

Identifying your challenges

Even if a healthcare service or clinical workflow has been upgraded and modernised from an analogue to a digital system, it hasn’t necessarily been ‘improved’ by having had its original legacy challenges solved from a workflow point of view. Far from being a panacea of effective healthcare delivery, EHR implementations risk taking poor paper-based workflows and digitising them, delivering little benefit. This doesn’t mitigate any of the time demands on staff—in fact, it may even exacerbate them. It also doesn’t address the difficulties surrounding resource availability. Yet successful incorporation of these digital applications is one of the highest priorities for health organisations.

Staff and patients alike may struggle with adapting to an EHR implementation, seeing it as a disruption of “the way things used to be”, with paper-based files and notes being replaced by laptop screens and keyboards. This can be challenging for those who may not be tech-savvy or haven’t received suitable application training.

To pluck out an especially egregious anecdote we heard recently, patient-facing staff at a maternity hospital had to fill out several fields every time they engaged with mother or baby. It had become so time-consuming they’d ended up using a shortcut by entering any character in the data fields and hitting Return just so the form would accept they’d been filled out. The staff had found the path of least resistance to following this new digital workflow, but they wouldn’t have needed to find that path in the first place if that poorly designed process hadn’t been embedded within their core daily duties.

“I’ve digitally transformed so much technology in this establishment, yet I feel all I have now are digital silos instead of analogue silos. It’s like nothing has really changed, never mind transformed. Things aren’t talking to each other, everything’s separate. When is this promised ‘digital transformation’ supposed to happen?”
—The perspective of one hospital CIO

Humans have a natural resistance to change, and nowhere is this clearer than in healthcare, where avoidance of change is understandable, even preferable in many circumstances. Change means disrupting the norm, and that represents the risk of errors creeping in, or of tried-and-tested processes breaking down entirely. Whenever you read a list of ‘Biggest EHR challenges’, you’ll see that introducing technology and getting staff conversant with it is always right there at the top.

To ditch or keep the pager: solving an age-old dilemma

If you look closely, legacy communication devices are alive and kicking in every corner of apparently high-tech healthcare organisations. There’s the classic pager, of course, but also the perennially popular IP–DECT phone.

These devices have served us well, but increasingly they’re becoming obstacles to effective and efficient communication and collaboration in the modern digital healthcare environment. There are plenty of pager systems still in use, a perfect example of “That’s just the way we do things.”

Given their ubiquity, it’s perhaps surprising to hear many healthcare staff say they actually dislike pagers. The problem is they’re so used to rudimentary technologies and their associated hospital workflows that new technology solutions like EHR, integrated SSO and digital communications seem too disruptive, even troublesome.

Yet consider this: when two staff quickly exchange information verbally, it takes maybe 20 seconds. Paging takes longer—a lot longer. The recipient needs to find a phone, listen to the message, then respond.

Physicians also report that ‘one-way’ forms of communication—like pagers—negate vital back-and-forth discussions with their fellow clinicians, which are critical to synthesising timely and accurate diagnoses. In fact, they feel that communicating in this way is a source of potential errors.

But with so many staff accustomed to their pagers, how do create buy-in? How do we build excitement around a new solution, integrated technology that improves workflows, saves time, and boosts the employee experience? By demonstrating to healthcare practitioners the benefits of integrating realtime communications and collaboration within the EHR interface, and how this streamlines workflows for all.

Implementing EHR solutions is extremely technical and resource-demanding, no doubt about it—but it’s critical in the digital transformation of healthcare organisations. But it’s achievable if healthcare institutions can learn to shape the technology around the staff, not vice versa. Integrating elements like realtime communications and collaboration will help bring about successful adoption of EHR solutions by staff, and they’ll soon see the value these technologies can bring to their jobs. That’s where Avaya can help.

Interoperability: the key to removing digital siloes

In the language of web services and application programming interfaces (APIs), interoperability is when systems ‘speak’ to one another. For more and more healthcare organisations, this is becoming the expectation rather than the aspiration.

A lack of interoperability can hinder care coordination and delay successful health outcomes. And while there’s no single solution to integrate all systems, individual integrations can be non-repeatable because healthcare workflows, processes and services are often unique to particular patients, staff and hospitals.

The flexibility to adapt must sit at the core of all digital entities and their interoperability frameworks. This openness to integrate an EHR with your communications platform opens the door to unprecedented workflow possibilities for your staff, which can transform the delivery and coordination of care. By deploying new thinking to digital workflows, you can break down old silos for good.

Case study: elevating the Johns Hopkins patient experience

The Johns Hopkins Healthcare System is consistently recognised as one of the best of its kind. Avaya helped hone the JHHS even further with screen pops, which accelerate the processing of patient calls coming into the contact centre. This saves staff time in dealing with calls because the patient record is presented to the agent automatically.

Having this functionality available from within a desktop or laptop experience (from within the browser) also makes the process far more convenient for increasingly remote agents, who now need far less complex technical setups to carry out their roles.

Removing silos and transforming digital workflows with the EHR

1. Appointment self-management and notifications
Give patients more freedom to self-manage and self-inform. With rules-based logic applied to appointment booking and notifications based on data from their EHR, the most relevant scenarios and permissions are applied automatically.

2. Prescription or medication reminders and notifications
Provide simple yet valuable patient aftercare with rules-based logic through your communications platform, based on a patient’s data in their EHR.

3. Patient satisfaction surveys
Automatically trigger requests for and collect patient feedback on services received as indicated in their EHR patient record, and simplify the relevant staff’s ability to get notified about and view this feedback.

4. Lab test results, aftercare treatment plans and medication allergy notifications
Improve holistic communication between patient and clinician with tailored advice, updates and recommendations based on the patient’s unique combination of conditions and medications, according to their EHR. Imagine the time saved if treatment plans were standardised and automatically distributed based on this data.

5. Automated identification and validation for patients accessing services
Simplify service triage and connect the patient to the relevant skilled services more efficiently by automating communication and data gathering, pulling on data available in their EHR patient record.

6. Screen pops and click-to-call features for agents
Enable agents to quickly reach, authenticate, and authorise the patient, or any clinician or department associated with them, from directly within the EHR.

7. Copies of call log or recording links placed into a patient’s record
When a call with a patient is recorded by the communication system, the link to it can be embedded automatically in their activity record. The ability to display call records in the patient’s record is also helpful because it enables the doctor to see the history of calls from that individual.

8. Dynamic links to on-call schedules in an EHR with realtime communications
A huge day-to-day frustration for staff is being unable to speak to critical clinicians like on-call specialists without having to walk around to find them or chase them on the phone (and invariably only getting through to voicemail). With EHR integration they can easily click-to-call on the role speciality, and have that call go through directly to the clinician on shift. Being able to link the communications service with the intelligence in the EHR for staff schedules brings out the best in both technologies.

9. Easy click-to-communicate from within the EHR
Being able to call or collaborate with individuals, teams or specific roles from a laptop or from an app on a smart device makes communication easy and intuitive for those not confident in using technology.

Case study: streamlining workflows for Mayo Clinic

We merged Mayo Clinic’s EHR app with a single sign-on (SSO) feature and click-to-communicate to produce a single experience, meaning staff could be called from directly within the EHR. This moulded technology into easier workflows rather than shoehorning staff into technology.

Increased staff adoption of the EHR simplified a key part of their day-to-day workflow: contacting other team members. The click-to-call feature enables the user to continue working within the EHR and make calls or collaborate as and when they need to, without having to jump between webpages.

Think connected to improve experiences for staff and patients alike

Digitisation is a noble aim for healthcare organisations, but on its own it’s not enough to relieve staff of the preexisting challenges embedded in their workflows.

But by intelligently combining transformative EHR technology and digital communications and collaboration solutions, staff can break down their analogue-cum-digital silos to enjoy better processes and patient outcomes than ever.

With Avaya, healthcare providers worldwide are discovering the benefits of dovetailing EHR and communications platforms together to create workflows greater than the sum of their parts.

To find out the ways we’re enhancing communications and collaboration across the NHS, check out our eBook: Think Connected Across the NHS.