Antidotes & Anecdotes

Optimizing EHRs With App-based Tools


It can be a tough choice, but probably not as complex as the decision-making process that many hospitals are facing with their legacy EMRs. Over 95 percent of hospitals have implemented EMRs, but many physician end-users feel the technology is somehow “broken.” In fact, the very tools that were intended to improve efficiencies and enhance the delivery of patient care is creating widespread physician dissatisfaction and contributing to physician burnout and being blamed for lost productivity and decreased patient face-time.

Healthcare executives are now faced with a question: should they try to fix their broken EMR implementation or should they implement a brand-new solution?

Replacing an EMR is obviously an expensive and disruptive option that doesn’t always lead to happier end-users. According to a Black Book survey, 14 percent of all hospitals that have replaced their original EMR since 2011 were losing inpatient revenue at a rate that wouldn’t support the total cost of their replacement EMR. Furthermore, 87 percent of hospitals that were facing financial challenges now regret the decision to change systems.

Rather than replace the EMR, a hospital may seek to optimize its current EMR by enhancing its usability and adding additional functionality that adds value for the organization. Many health systems prefer this route, as evidenced in a 2017 KPMG/CHIME survey that found 38 percent of CIO respondents intend to spend the majority of their capital on EMR optimization over the next three years.

EMR optimization can take many forms and can address a multitude of issues. From a technical perspective, one increasingly popular approach is to deploy app-based solutions that take advantage of open standards such as FHIR and CDS Hooks. Such innovations are allowing health systems to add new features and functions to their existing EMR platforms without having to rely on their EMR vendor to develop the desired enhancements.

Consider, for example, a hospital that wants to give clinicians advanced clinical decision support (CDS) tools that reflect the latest clinical evidence and work behind the scenes during a patient encounter. Such a solution could increase patient safety and improve outcomes. Ideally, alerts should be patient-specific and based on both the structured and unstructured data in a patient’s chart.

While many legacy systems include basic CDS tools, many remain unused because they disrupt workflows, are cumbersome, fail to consider unstructured data, don’t work well with clinician workflows, and/or are difficult to update with the newest clinical content. However, CDS tools, especially when based on current evidence and available at the point of care, can help a clinician avoid errors of omission or commission (eg, forgetting to order a medication that has been proven to improve outcomes such as mortality, length of stay, and readmission) for a patient’s specific condition, or ordering a drug that could cause harm in combination with the patient’s other therapies or comorbidities.

EMR optimization tools, especially those designed to work at the point of care, should not be intrusive, nor contribute to alert fatigue. If the tool is a CDS app, physicians will be more likely to embrace the solution if alerts are limited to critical events, such as a physician deviating from an expected pathway based on clinical guidelines.

As a physician, I understand that EMRs are sometimes frustrating and inefficient, but I also recognize the benefits of advanced clinical tools–such as evidence-based CDS solutions–to drive clinical optimization. As developers continue to introduce innovation apps, health systems will have more opportunities to drive EMR optimization, as well as improve the satisfactions of their physicians and increase the ROI for their technology investments.


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Categories: Technology,Thought Leadership

About the Author

Robert L. Kass

Robert L. Kass, MD, is a managing editor at Zynx Health, where he is responsible for the development and maintenance of medical content. Starting his career as a board-certified family physician, Dr. Kass transitioned to practicing and teaching geriatric medicine, a field in which he felt that evidence-based practice was crucial to help patients maintain quality of life, maximize function, and avoid unintended consequences of treatment. He was thrilled to get the opportunity to help other physicians to achieve evidence-informed care for their patients by joining Zynx Health in 2006. Dr. Kass resides in Boston with his wife and daughter. Together they enjoy music, theater, and other attractions of city life, with frequent trips to the Berkshires of Western Massachusetts for outdoor activities.

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