A Beautiful Cloudy Day: Cloud-Based EHRs on the Horizon

Increasingly, electronic health records have the potential to make care mobile. Pulling up PACS images, analyzing labs and vitals, even computerized physician order entry can routinely be done remotely.  But this more streamlined, now routine, care is only the beginning. True EHR mobility encompasses both acute and chronic care decisions, inside the hospital and outside the hospital.

Legacy, on-site systems can struggle to keep pace. Forget coordination of care across an increasingly fragmented delivery system. Just try asking for new features. Consider the story of Dr. Rocky Bilhartz: a tech-savvy cardiologist with a simple idea to improve routine patient care. He made a feature request for streamlined heparin drip protocol in his hospital's on-site EHR. Heparin drips demand more nursing and physician attention on the floor than many other protocols; surely an EHR template would help coordinate dosing, timing and laboratory monitoring of the patient's blood. That request languished for three years.  Hopefully, Dr. Billhartz is not holding his breath.  

His story is not uncommon. Legacy, on-site EHRs often feature IT teams that can rival clinical teams in size yet feature or even security updates come in downtime fits and starts. Providers may be well served to outsource software management, purchase a service with changing features rather than a product with an on-site footprint.  Focusing on treating patients, rather than maintaining software at one site, seems obvious. After all, optimal patient care long ago began to span across multiple settings.

Healthcare has become increasingly complex, increasingly fragmented. A common enough patient's journey starts in the outpatient office, moves from the emergency department on to the hospital floor followed by discharge to a subacute nursing facility or long-term care. While reimbursement remains fragmented for now, soon enough care episodes will encompass the entire journey. True mobility in EHR provides real-time information at the fingertips of practitioners in any one of these settings and ideally across all of them. Lives are at stake.

One in four patients admitted to a sub-acute nursing facility are re-admitted to an acute care hospital within 30 days at a cost of $4.3 billion dollars. Long-term care facilities often face similar challenges regarding escalation of care. Readmissions are common, expensive and--with the attendant risk of infections, de-conditioning, poly pharmacy--dangerous. Cloud-based EHRs can help turn the tide. Jean McGill, the Clinical Services Director of the American Baptist Homes of the West long-term care facilities, explains to EHR Intelligence that cloud-based EHRs allow better care coordination with multiple providers. "The ability for all parties that need to be at the table to help make the clinical decision in an emergency situation to have the information in front of them improves many of our decisions that would have in the past automatically sent patients back to the hospital."

The future does indeed look bright.  Real time data in the hospital should already be here. The future will link EHRs to medical devices and wearables.  The future involves better data from patients to provide truly personalized care.  The future is already here, although it's yet to be evenly distributed.  Already providers can analyze home blood sugar levels or pulmonary artery pressures with CardioMEMS.  Providers can message each other to discuss next steps and even text their patients. It's hard to imagine running towards this future tethered to on-site hardware.

Andy Matthews's picture

Andy Matthews

Contributor

Andy Matthews, MD is a resident physician in internal medicine. Prior to his medical training, he worked in life science consulting for Leerink Swann as an analyst and then as associate. He continues to consult on biotechnology valuation, healthcare reform and other key issues shaping healthcare.

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