Electronic health records (EHRs) have been at the heart of an ongoing revolution in healthcare—but they've also caused plenty of headaches over the years, particularly as they've gotten older.
So technology and clinical leaders at New York City-based Northwell Health said they're taking matters into their own hands to build what they call the "next-generation EHR" with innovation and physician usability in mind.
The health system is working with EHR giant Allscripts to develop a cloud-hosted, voice-enabled, artificial intelligence-based EHR.
Most EHRs are built on technology that is 20 or 30 years old. The new IT system will be designed and tested using input from Northwell clinicians, IT experts and administrators with the goal of ultimately deploying it systemwide, the health system said.
The EHR being developed will not be exclusive to Northwell Health. As part of the deal, Allscripts will help build the EHR to then sell it as a commercial product to other health systems.
Northwell Health is New York state’s largest healthcare provider with 23 hospitals and about 750 outpatient facilities. The health system serves about 2 million people annually in the New York metro area. Northwell has 70,000 employees—16,000-plus nurses and 4,000 employed doctors. The health system also has 13,600 affiliated physicians.
"We recognize the burden that EHRs place on our physicians. Our physicians feel that EHRs were not designed by them and the systems don't function the way physicians function, " Northwell Health Senior Vice President and Chief Information Officer John Bosco told FierceHealthcare.
Current EHR systems on the market today are generation 1.0, Bosco said. They are expensive to maintain, and clinicians complain the user interfaces are clunky and require too much manual data entry, he said.
"EHRs detract from provider efficiency and don’t optimize the care of patients as well as they could," he said, noting a major complaint from physicians is the amount of typing and clicking involved with using EHRs.
The EHR system under development with Allscripts will incorporate modern technology capabilities to save physicians time and increase efficiency. Voice-enabled features will help with data entry. AI capabilities will help sift through clinical information to ensure physicians are presented with the patient data that are most relevant to them during the patient visit.
"We think AI can help the EHR to learn physician preferences and then tailor the system to fit those preferences," Bosco said.
AI and machine learning capabilities also will enable better clinical decision support. The new EHR will be designed to incorporate data sources such as patient-generated data from wearables and other internet of things devices, he said.
The EHR project also will focus on improving care delivery for patients by providing them with better digital tools.
"We believe patients own their medical data, not doctors, hospitals or health systems. We want patients to have easier access to that data and for that data to be presented in a way that helps patients be more involved with their own health maintenance," Bosco said.
Pilot EHR to be rolled out in 2021
Northwell and Allscripts are not starting from scratch to build the EHR but will use Allscripts' Avenel platform as a foundation. The health IT vendor launched the cloud-based Avenel platform in March 2018, touting it as the first machine learning EHR.
"We looked at it and we thought [Avenel] had some good technology underpinnings but it was in an immature state," Bosco said. "We’re going to bring that back to our usability lab."
Allscripts will provide expertise in software development, product management and systems integration as part of the collaboration, and Northwell will provide clinical end-user expertise. Northwell physicians will be heavily involved in designing, testing and piloting the EHR system. "We're going to broadly solicit input from them to understand what they see as the foundational elements of a next-generation EMR," Bosco said.
The design phase will take about a year, and then the project team will move into software development. Northwell Health plans to begin piloting the new EHR in 18 to 24 months among some ambulatory providers. The goal is to transition all ambulatory providers to the new health IT platform, Bosco said.
In the meantime, Allscripts and Northwell will continue to support and enhance its current EHR platforms Allscripts Sunrise at Northwell hospitals and Allscripts Touchworks currently in use at more than 750 outpatient practices.
The organizations did not disclose the cost of building the new EHR system.
"Northwell and Allscripts are going to put significant resources into this, including clinicians' time and financial investment," Bosco said.
Northwell Health executives anticipate the EHR system developed with Allscripts will be less expensive to deploy and maintain.
"EHRs are burdening health systems, hospitals and physician offices with very high technology costs. We’re hoping that a cloud-based EHR that takes advantage of newer technology will help to make this a less expensive proposition going forward," Bosco said.