If I were to map out the phases of EMR, it would look like this:
- EMR Adoption. Rapid EMR adoption and implementation fueled by the generous government incentive program (Meaningful Use)
- EMR Consolidation. Providers either decided to switch to a different EMR or were forced to change due to the consolidation or shuttering of their original vendor
- EMR Optimization. Organizations focused on improving the usability and effectiveness of their EMRs by adding customization, upgrades and training.
I believe most healthcare organizations are still in the Optimization phase, but a growing number are transitioning to the next phase, something I think of as:
- EMR Extension. Using the EMR as a foundation for enhanced care. Adoption of new add-on modules and solutions that use the EMR as a platform to both source and store data.
This next phase continues the evolution and maturity of EMRs. With over a decade of continuous investment, healthcare organizations of all sizes are looking for ways to better leverage the data, workflows and connectivity that they have baked into their EMR systems.
Integration extends EMRs
To deliver enhanced care, tighter integration between EMRs and applications developed by innovative 3rd party vendors needs to be in place. This means EMRs need to become more open and easier to access.
In the early days, EMRs were walled gardens with vendors each vying to build the most comprehensive functionality stack. If you needed anything, the EMR vendor would have their own module for it. That was a successful formula, but it is ultimately not sustainable. History tells us so (looking at you IBM, Kodak, and Sony).
Some EMR vendors are stubbornly sticking with a walled-garden approach, but many more are making it easier for others to connect with their platforms. Whether this change in approach is due to increasing customer pressure or pending regulations (ie: info blocking) the net effect is that healthcare organizations now have more flexibility and choice when it comes to extending the use of the EMRs. They are no longer restricted to just the modules provided by their EMR vendor.
Seamless end-user experience is key
Tight integration with an EMR is just the first step. What is also emerging as a key requirement is a seamless end-user experience.
In earlier phases, staff loathed using EMRs. But over time they have become tolerant of them and grown accustomed to their idiosyncrasies. The transition to EMRs was painful and frustrating. It is understandable, therefore, that no one wants to repeat that experience and shy away from adopting 3rd-party applications that require learning a whole new system.
It is ironic, but given a choice, healthcare staff would prefer to remain with the familiar confines of their EMRs rather than have to click over to another application to do something. The same applies to IT administrators and power users. They too would prefer to have everything controlled by their EMR rather than having to go to multiple systems to control/configure the environment.
Smart vendors are recognizing this unwritten requirement and building their applications to provide a seamless experience for end-users and administrators alike.
An EPIC-integrated chat bot
Asparia, a company that makes an Epic-integrated chatbot (they also integrate with other EHRs) that automates patient communications, is one company that has invested the time and effort to make its solution a seamless experience for patients and staff.
Yes, THAT Epic.
I had the same reaction when I learned what Asparia had done. Epic has a reputation for being difficult system to work with. I have heard many stories from companies that have tried and failed to work with the EMR giant. That reputation, however, may be slowly changing.
Asparia saw a need in the Epic user base for a best-of-breed chatbot that could not only use the patient and process data, but also write back information about the chatbot’s interaction with the patient in the EMR. Asparia did the hard work to learn and code to Epic’s APIs so that end-users can remain within Epic Hyperspace and see the patient’s responses to their chatbot.
Furthermore, Asparia’s chatbot can be triggered by activities within Epic.
Patients happy and staff unburdened at ACPNY
On a recent webinar that I hosted, Tia Fagan who leads digital patient engagement at Advantage Care Physicians in New York (ACPNY) – one of the largest primary and specialty practices in the New York area, providing quality, personalized care to over half-a-million patients – walked through an example of how data from Epic spawns pro-active outreach by the Asparia chatbot:
“As you know, a colonoscopy is an unpleasant experience for patients. It is also an expensive procedure costing in the neighborhood of $5,000 per patient. To ensure the patient is adequately prepared, most clinics hand out instructions to patients, usually on paper. Often, a nurse sits down with the patient and reviews those instructions.”
Now after doing all of this, just imagine the disappointment when the doctor decides to abandon the colonoscopy after starting the procedure because the patient is not adequately prepared. Imagine how frustrated the patient would be having to undergo this unpleasant experience once more.”
Having implemented Asparia, patients now receive a reminder of their upcoming colonoscopy via a chatbot that can interact with them via SMS. When they confirm the appointment, they receive any important instructions.
“With the tight integration with Epic, Asparia chatbot picks patients’ language preferences directly from Epic,” explained Fagan. “The bot asks patients to respond to confirm, cancel, or reschedule. When patients confirm the appointment, they receive visit specific instructions as well as department specific instructions. We already have these instructions in Epic and Asparia uses them. If tomorrow, we feel a need to change these instructions, we will make those changes in Epic and the Asparia chatbot will start to use the new instructions. When the patient confirms the appointment, Asparia updates the appointment status in Epic.”
The deep integration with Epic also means that the chatbot can handle the complex situation when a patient opts to reschedule an appointment. Instead of funneling the patient to a call-center to speak with an agent like many text-only based solutions have to, Asparia’s chatbot Is able to pull available appointment slots from Epic and offers them to the patient. Once a choice is made by the patient, the new appointment is booked and the original is canceled in real-time.
The end result is happy patients (they get quick and painless interactions in their preferred language) and unburdened staff (who do not have to learn a new system to see/control the interaction that the chatbot has with patients).
Lack of integration was a non-starter
“Late last year, I was originally looking for a gateway to send SMS to patients from Epic,” shared Fagan. “I called a few companies based on a Google search for ‘Epic SMS Gateway’ and arranged several demos. But I found challenges with solutions that required users to leave Hyperspace and log into another application. That was a deal killer for us from an infrastructure and a training perspective. How do we build adoption and enthusiasm for patient engagement if it means more work, more apps, more training?”
In the end Fagan and ACPNY chose a solution that provided a seamless experience and was deeply integrated with EPIC. As we continue to transition into the EMR-Extension phase, stories like ACPNY’s will (hopefully) become more and more commonplace.
To hear ACPNY’s full experience, check out the recording of the recent webinar.
Disclosure: Asparia is proud sponsor of Healthcare IT Today