The electronic health record is the lynchpin of healthcare information technology. And it has been evolving at a consistently quick pace in recent years.

Healthcare CIOs seeking to ensure they are making the best EHR investments today for the years ahead would do well to listen to experts in the field offering an insightful look ahead at the future of EHRs.

We checked in with Epic Systems President Carl Dvorak, Allscripts CEO Paul Black, an Accenture consultant and drchrono founder Daniel Kivatinos to get a sense of where big and smaller EHR vendors are headed.

[Update: ONC kicks off $80,000 EHR safety contest]

Epic’s Dvorak singled out automation analytics, genomics-informed medicine, telemedicine and next-generation analytics as areas that will impact the EHR.

“Automation analytics: Akin to a flight data recorder, collecting information about how providers are using automation in the care and administrative processes will be a significant leap forward in reducing costs, increasing efficiencies and reducing harmful variation,” Dvorak said. “This holds the key to unlocking some of the secrets to physician well-being. For example, we can avoid work being unnecessarily diverted to physicians when it could be better managed by others.”

The advent of genomics-informed medicine also will be key to the future, he said. As part of an effort to incorporate social determinants into patient care, genomics-informed medicine allows caregivers to tailor healthcare precisely to the needs of the individual, as they best understand them today, he added.

“On a deeper level, it also helps us form a more detailed understanding about how disease forms and what clinicians and patients can do to influence outcomes,” he said. “Genomics-informed medicine gives us insight into our personal futures – which may help guide, direct and motivate our preventive healthcare behaviors. It can also be considered our ability to see into the future on a few dimensions.”

[Also: Next-gen analytics: Here's what's coming in the future]

On another note, the evolution of telemedicine will affect how EHRs are viewed and used, Dvorak predicted. Delivering care virtually allows healthcare organizations to reengineer care processes and care delivery at a much lower cost, while maintaining high effectiveness and improving outcomes, he said.

“More specifically, there are significant opportunities to leverage remote patient monitoring with consumer- and medical-grade devices that can stream information to a clinical process via an algorithm or human, where appropriate,” he said. “In addition, there’s great promise in consumer diagnostics that allow a patient to reliably test for conditions in the home, while transmitting the results of those tests back to their medical institution, which may also be transmitting back to an algorithm or human.”

The ability to maintain a personal connection with a provider through video and other technologies has proven to benefit patient experience and convenience, while at the same time allowing health systems to reduce the total cost of delivering care, he added.

And the next generation of analytics will have an impact on EHRs and what they are used for, Dvorak said. At first, the next generation of analytics will seem more magical than the reality behind the scenes, he said. However, fairly soon, this functionality will turn out to be even more magical than healthcare executives could have imagined, he added.

“In particular, machine learning and predictive models allow us yet another way to see into the future and even help prevent adverse outcomes in real time – such as sepsis and other forms of deterioration or complications,” he said. “At the same time, analytics will help us maintain our health and well-being by providing guidance on what we can do to prevent adverse outcomes that would otherwise be inevitable without intervention.”

When it comes to next-generation EHR features, it is becoming more challenging to retrofit EHRs to take full advantage of new innovations – such as the cloud, machine learning and mobility. These three areas are top of mind for Paul Black, CEO of Allscripts.

One of the biggest concerns in the industry today is physician fatigue and issues around how they are spending an increasingly large amount of time with the computer versus the patient.

“We believe using human-centered design will transform the way physicians experience and interact with technology, as well as improve provider wellness,” Black said. “The industry needs an entirely new approach to the EHR. We’re seeing a huge need for the EHR to be mobile, cloud-based and comprehensive to streamline workflow and get smarter with every use.”

"The industry needs an entirely new approach to the EHR. We’re seeing a huge need for the EHR to be mobile, cloud-based and comprehensive to streamline workflow and get smarter with every use."

Paul Black, Allscripts

In general, the cloud can reduce the total cost of ownership of IT while improving scalability and security. The cloud offers many advantages to users, Black insisted.

“For example, with cloud solutions they don’t have to deal with maintenance, equipment, upgrades and security,” he said. “Public cloud-based EHRs offer advantages over traditional private cloud-based EHRs, which are often a software as a service model.”

With machine learning, the IT learns what works best for a healthcare organization for maximum efficiency.

“We’re incorporating machine learning capabilities to learn our clients’ treatment patterns,” Black said. “It can pre-populate information based on these patterns and deliver preference reminders. It’s constantly surveilling trends by user, organization and region to create opportunities for more efficiency.”

Plus, the power of machine learning surfaces information relevant to the encounter in real time – which helps improve quality and immediate interaction with the patient, he said. Ultimately, this reduces the amount of time spent on documentation, helping address the problems of EHR fatigue and physician burnout, he added.

And mobility gives the user what he or she needs, when and where he or she needs it, Black said. Many EHR companies have released companion mobile apps that offer a subset of the functionality in the EHR. Because the experience is limited, users have begun to dismiss mobile solutions over time, Black contended.

“By offering a new approach to mobility, with 100 percent of the EHR workflow in a user-friendly environment, the full power of the EHR will be at physicians’ fingertips, which means they are better informed and better able to engage directly with patients,” he said.

While several EHR vendors are developing cloud-based inpatient and outpatient electronic health record systems, these products are a few years away from meeting the needs of a full-service medical center, said Kip Webb, MD, consulting giant Accenture’s provider practice lead.

“Look for the vendors to implement EHRs in smaller hospitals and critical access facilities first, and work upstream from there,” he said. “In the meantime, I expect to see Epic and Cerner grow their footprint in the small to mid-size hospital market.”

There are two important product lines currently in development among the major EHR vendors, Webb added.

“The first product line is in the field of population health,” he said. “Currently, these products are displacing niche registry vendors primarily using EHR and claims data. Over time, these products will consume more data, including data related to the social determinants of health, thus enabling true population health management.”

The second product line is increasing analytic capability, including artificial intelligence. As was true with population health, this product line will be an incredibly important arrow in the quiver, he said. Not only will it enable healthcare executives to better understand the most vulnerable patients and the care they require, but it also has the promise of moving some work off the busy clinicians’ plate, he said.

Daniel Kivatinos, founder of EHR, practice management and revenue cycle systems vendor drchrono, said the next generation of EHR features and functions will be very interesting, and there will be a lot of attention on the cloud and APIs.

“Many EHR vendors are locked to data centers in the basements of medical facilities,” he said. “Is having an expensive IT staff and having a huge server farm infrastructure worth it? This way of operating for decades has been impeding on innovation. Do you recall the days of having all of our banking in just one bank location when nothing was digital and you would go to your local bank to get paper cash? Do you recall when ATMs started popping up?”

The currencies industry went digital in a big way. It allowed innovation from companies like Square to build ways to take payments from a phone to companies like Apple to create Apple Pay and Apple Pay Cash. Now it is all in the cloud.

“Moving forward, healthcare CIOs should understand that the industry is moving to the cloud,” Kivatinos said. “Looking to the future will benefit innovative healthcare institutions in many ways in the long term. Perhaps one of the biggest ways having a fully cloud-based EHR will change the way we as an industry operate will be enabled API access.”

APIs are powerful. Brilliant developers inside and outside the healthcare industry can join forces with a healthcare organization in a very fast way.

“As a CIO, you will be able to test apps without having to have massive timelines, long setup times, and adding to costs within the organization,” he said. “With APIs and testing apps at a fast rate, you will see what is working and what isn’t working quickly. You will be able to add other partners into the mix that just weren’t available before when you have a local EHR install only.”

Enabling a cloud EHR, he concluded, will ensure the long-term success of a medical institution getting access to additional components and partner apps through modern cloud APIs.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com