Top 10 EHR stories of 2020

From pandemic-necessitated go-live pauses to major rip-and-replaces, FHIR-based efficiencies to interoperability strides, digital records are evolving.
By Mike Miliard
11:57 AM

Like 'em or hate 'em, electronic health records are here to stay. Now it's just a matter of making them work to the best of their ability for patients and clinicians.

Some recent efforts are afoot to rethink the approach to these glorified billing systems from the bottom up. Others are focused on refining and streamlining their user experience to combat the scourge of burdensome charting and alleviate burnout.

In the meantime, with more than 18 million COVID-19 cases and counting so far in the U.S., it's never been clearer that interoperable, ideally telehealth-connected digital records are essential for quality care and public health going forward.

Here are some of the most-read EHR stories of the past year.

EHRs are still a mess for physicians, but change is coming. The top-grossing article on this topic for 2020 was a hopeful piece written on Dec. 31, 2019. (And we all know how most of those hopeful New Year's Eve wishes went by now.) Still, progress has been made on some of the issues it highlights: taming an "avalanche of data," enabling easier voice documentation and streamlining clinician workflows.

Epic pushes out software update to help spot coronavirus. Way back in January, as concerning news reports described the emergence of a virulent new threat in China, Epic introduced a new module to its systems designed to help providers "detect potential cases of the Wuhan novel coronavirus, or 2019-nCoV."

Atrium Health to drop Cerner, move to Epic EHR system. Charlotte, North Carolina-based Atrium Health, with more than 40 hospitals and 900 outpatient clinics, announced its transition from Cerner to Epic in February. It was the second major health system to announce such a switch in 2020; that same month, 50-hospital AdventHealth announced a similar move, citing a similar desire for a connected enterprise-wide network.

VA to delay rollout of Cerner EHR system, citing interoperability issues. "After rigorous testing of our new EHR, the department will need more time to complete the system build and ensure clinicians and other users are properly trained on it," said a VA spokesperson in February. "We believe we are 75-80% complete in this regard and will be announcing a revised 'go-live' schedule in the coming weeks."

How EHR vendors are arming providers to handle COVID-19. As the pandemic began to take hold in the U.S., we called around to the major vendors – Allscripts, athenahealth, Cerner, Epic, eClinicalWorks, Meditech – to hear how they were fine-tuning their systems with new tools and capabilities to help clinicians respond. The companies also described how they were taking steps to protect their own workforces from infection with new work-at-home policies.

First-ever Cerner 'virtual go-live' helps one hospital roll out EHR during pandemic. This install showed that, even working at home, vendor staff could help hospitals with major implementations remotely during COVID-19. Staff at rural Macon Community Hospital worked with Cerner associates to take the process online. “A skilled IT staff, dedicated department leaders and the right vendor can replicate an on-site implementation in a virtual environment," said the hospital's CEO.

Lyft to integrate with Epic, enabling ride scheduling within EHR workflow. Similar to other recent rideshare-EHR partnerships with Allscripts and Cerner, this one aims to ensure that transportation is not a barrier to care. (Nearly 30% of facilities using Epic already partner with Lyft for nonemergency medical transportation.) Lyft said it would work toward measuring the outcomes of such partnerships, "potentially even tracking patient segments to proactively identify patients that would benefit" from a ride.

Coronavirus pandemic puts focus on strengths, weaknesses of EHRs. "A central problem the COVID-19 pandemic has highlighted is the fact that EHR systems are large, slow monoliths that don’t quickly adapt to new, emergent demands on their design and workflow," wrote Healthcare IT News correspondent Nathan Eddy in March. As one nurse informaticist told him: "We know how an EHR responds when we test 100 patients a day for COVID-19, but how does it respond when I test 1,000 or 2,000 or 10,000?"

FHIR-based system for EHRs cut search time from 3 minutes to 5 seconds. An initiative from the Regenstrief Institute, the Indiana Network for Patient Care and the Indiana Health Information Exchange leveraged HL7's ever-useful interoperability spec to achieve some notable gains in clinical efficiency. "FHIR can help us accelerate innovation on top of EHR platforms, which is sorely needed," said one researcher. "EHR vendors can’t produce every single innovation and fix that we need in health IT systems. With FHIR, we collectively can."

Clinician burnout correlates with volume of EHR patient call messages. A study from the Journal of the American Medical Informatics Association found that clinicians with high volumes of patient call messages had almost four times the odds of burnout compared with those with the fewest. Researchers also found that EHR-based efficiency tools – the ability to copy and paste notwithstanding – weren't associated with decreased odds of burnout. "In fact, these suggested efficiency tools may not provide for or measure efficiency at all," they wrote.

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

Healthcare IT News is a HIMSS publication.

Taking Stock of Progress and Looking Ahead

This December, we look back at a challenging year – and forward to what we hope is a better, stronger, more connected and resilient healthcare ecosystem.

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