The shift to value-based quality care is happening. Hospitals and health systems have already invested time and money into electronic health records. Years later, the tangible benefits these systems seem to have generated are the creation of clinical data repositories and a more efficient revenue cycle.

Hospital EHRs have left gaps in the support of nurses and other frontline clinicians who represent the vast majority of the healthcare workforce. This is because EHRs aren’t able to efficiently deliver contextual clinical data at the point of care or offer essential communications tools to collaborate with care teams.

In turn, nurses have designed their own workarounds to compensate for the inefficiencies that EHRs have introduced to their workflow and processes. Many clinicians still jot notes on paper and 67 percent of nurses leverage their personal smartphone to communicate with the care team and look up information to support patient care. 

In the post-EHR era we are entering, healthcare organizations must take advantage of mobile trends among clinicians and patients. Layering smart mobile applications as an adjunct to EHRs can efficiently optimize care design, transitions of care, provider hand-offs and leverage stored data to orchestrate workflows, people, processes, decision making and improve clinical communication across trans-disciplinary care teams.

Filling EHR gaps

Despite the disruption and expense associated with implementing EHRs and attesting to Meaningful Use, a recent study commissioned by the American Hospital Association found that some health systems still struggled to meet clinical quality goals with their EHRs. There are a number of inherent limitations in EHR technology, including:

• Monolithic structure: Many EHRs are built on decades-old technologies that grew into complex solutions that now require a significant investment of people, resources and IT infrastructure to use and maintain.
• Focus on order entry: Most apply EHRs for physician order entry and generating the necessary information for coding and billing. In other words, they are good information repositories. The result is a clinical content, context and care plan data divide between the physician creating the electronic order and the frontline clinicians executing that order.
• Cumbersome user experience: In many instances, EHR documentation occurs at a desktop computer in a patient room or on a computer on wheels, making data entry and access unnatural to clinician workflow. As a result, documentation often is done after the fact—creating potential issues with accuracy, timeliness and completeness.

These gaps are where mobile technologies can begin to offer utility and value. Unlike EHRs, point-of-care mobile solutions are designed to deal with real-time interactions and to deliver immediate and contextually relevant information and communication. 

For example, mobile applications can help clinicians monitor, collect and process patient data such as vital signs in real time. Such applications go beyond secure texting to transmitting images as well as voice communication capabilities. Thus, by leveraging mobility and the cloud, clinicians can gain and communicate clinical data in context and orchestrate patient-centered care in order to deliver improved healthcare experiences and outcomes.

Reducing unnecessary care variation

The post-EHR era is one where the promise and potential of cloud and mobile come together to make EHRs easier to use, and to make care processes safer and more consistent between facilities and clinicians. That reduction of unnecessary care variation can reduce costs and enable higher quality care, both of which are rewarded under value-based payment models.

Consider the typical total-knee or -hip replacement procedure. This common surgery offers numerous opportunities for mobile solutions to improve the efficiency and safety of the pre-admission, inpatient and discharge processes by delivering contextual clinical data to both clinicians and patients at the right time.

• Pre-admission: Clinicians could confirm that the patient had fasted, watched educational videos about her procedure and that the patient’s medication list and lab results were updated and reconciled against the hospital’s EHR. These updates would give the surgeon and care team the confidence to proceed with the surgery with the most timely, accurate data.
• Inpatient: Insulin levels must be carefully monitored after invasive surgery. Some physicians require updates every 15 minutes after certain procedures. With mobile technology, the surgeon could check levels in real-time, even from off-site. Inside the hospital, clinicians’ mobile devices could prompt them to check levels based on whichever evidence-based intervals the providers wish to follow. If clinicians are concerned about the incision wound healing, photos taken with their mobile device could be securely sent to the surgeon for recommendations about antibiotics or wound dressing.
• Discharge: The patient and her family would be activated and engaged in recovery through their mobile device by accessing written post-operative instructions and educational videos, which the clinicians could confirm using their synched mobile platform. 

Throughout these few examples it is evident that mobile applications leveraged by clinicians and patients could eliminate instances of delayed patient care, phone-tag, communication gaps and information uncertainty that are possible during such a care episode. The improved data sharing and communication can help prevent care redundancy, variability and other wasteful processes while promoting best practices, a safer procedure and higher satisfaction.

Mobile bridges the digital divide

As healthcare organizations seek returns on their EHR investments beyond Meaningful Use incentive dollars, they should consider how EHRs can be enhanced by mobile applications that are engineered around the patient and focused on the interaction between patient and frontline care teams. Integrating mobile communications, clinical workflows and patient identification technology can enable a more engaging experience—as well as more effective outcomes—for both clinicians and patients.