Abby Burns (00:18):
From Advisory Board, we are bringing you a Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. I'm Abby Burns.

(00:27):
We've talked a lot on this podcast about ways provider organizations can become stronger operators, from talking about referral management to surgical scheduling, hospital throughput, the post acute relationship. It's all about optimizing care delivery operations, but there's an important piece missing from that list. Where does the patient history live? Where do you input lab orders? Where do you store disease registries, schedule appointments, take and store visit notes? That's right, you love to hate it. Actually, you might just hate it. I'm talking about the electronic health record.

(01:00):
My substantiated hunch is that most healthcare leaders don't actually know enough about their EHR at a strategic level. You know the functionalities you personally interact with or rely on the most, but not the full picture. And that matters for several reasons, not least of which is, if you're a provider organization, you spend a lot of time, money, and political capital directly or indirectly on your EHR, and our research suggests you're not using it to its full potential.

(01:30):
So today, we're talking about the EHR, and to help me out, I'm bringing three guests, Carol Chouinard and Jonathan Cooper, Vice Presidents in Optum Advisory's Division of Provider Technology. And Radio Advisory staple, Ty Aderhold, Director of Digital Health Research at Advisory Board. By the end of our conversation, you may not get to the point of loving the EHR, but I hope you'll get to the point of knowing how to better leverage it. Ty, welcome back. Carol, Jonathan, welcome to Radio Advisory.

Ty Aderhold (02:00):
Thanks for having me, Abby.

Carol Chouinard (02:01):
Thank you.

Jonathan Cooper (02:02):
Happy to be here.

Abby Burns (02:05):
So it's been about 16 years since the HITECH Act was passed in 2009 that led to really a massive expansion of the digital infrastructure in the healthcare industry, and really led to the rise of the electronic health record, the EHR. So that might make it seem like EHRs are somewhat old news, right? Important for our ops teams, for our IT teams, not necessarily prime fodder for a podcast conversation. I think you all would say differently. So I want to start our conversation with why. Why do you think it's important for EHRs to be back on the radar today in 2025?

Carol Chouinard (02:48):
As of two or three years ago, over 96% of hospitals were on an EHR.

Abby Burns (02:52):
Wow.

Carol Chouinard (02:52):
And over 90% of clinics were on an EHR, so, level of adoption is very, very high. I would say first and foremost, EHR is still a very relevant topic because our industry is structure has continue to change. As we go through consolidation, health systems continue to acquire, divest, we're seeing consolidation and the EHR is a key element in all of these transactions, all of these movements. That's one.

(03:20):
Second is that the EHR platforms themselves have evolved quite a bit, both in terms of their level of sophistication. They're doing a lot more in the areas where they have been revenue cycle and clinical management, etc, but they have expanded in scope as well. Really expanding into value-based care capabilities, expanding into the CRM type capabilities, and soon, we'll see them expand into the ERP capabilities. So the EHRs that we're looking at today that we're working with today, we are very, very different from where they were 10, 15 years ago.

Ty Aderhold (03:56):
And I also think the EHR is going to be increasingly important for organizations to consider as they bring in any new technologies or if they are considering bringing in AI models or AI solutions. First, their EHR is probably going to be the first place they turn to see, is that solution available through my vendor? And secondarily, how will I connect other solutions that I'm bringing into the EHR?

Jonathan Cooper (04:23):
I would say, we've been the busiest since my six years with Optum, just scoping new installs, which includes M&A activity of taking somebody that has Epic and adding another organization onto that existing instance and then also conversion.

Abby Burns (04:39):
Implicit in what you all are saying is this idea that yes, the EMR is at this point effectively ubiquitous, it is critically important, and yet some meaningful subset of the provider market is not using their EHR effectively or as effectively as they could be. First, I want to understand, is that a fair assumption for me to make from what you're saying? And I also want to understand what that actually means to you when you hear that.

Ty Aderhold (05:10):
I mean, I like to break it down in two ways. I think both, there are capabilities that organizations have turned on have access to that they're not effectively using at their system, and then there's also plenty of capabilities that may not even be turned on at an organization just based on where they were at the time of implementation and the upgrades they may or may not have gone through with.

Jonathan Cooper (05:36):
Agree, and I would even add that some organizations are likely even paying for some of these things in their service agreement that they aren't taking advantage of, which is even another conundrum.

Carol Chouinard (05:49):
And putting that in numbers, right? So at the start of really the big wave of EHR adoption, a lot of health systems were measuring their progress against the HIMSS adoption level, and as of recently, only 10% of the health systems in the country were at the top level seven of adoption because most vendors have their own kind of scale and ways to measure adoptions. It's about the same ratio, 10 to 20% only have achieved the highest level of adoption. And what has been happening is that the level of adoptions of health systems have stalled. Where the world are changing, we're transitioning to a value-based care mode where population health and care management and patient engagement, where all of these additional incremental capabilities are key to the performance and to some extent the survival in a number of health systems, the capabilities associated to these functions are just not being taken advantage of.

Abby Burns (06:46):
It's the number of things and the sophistication of things that you need to be doing as a health system is growing, and you're not necessarily able to take advantage of the tools that you might have at your disposal to do those things.

Carol Chouinard (06:59):
Exactly.

Abby Burns (07:01):
And it sounds like this is pretty widespread, if you said only 10 to 20% of systems are achieving the top level of adoption. What are some of the most common features that systems are overlooking, are not turning on in the first place?

Carol Chouinard (07:17):
I would say a lot of health systems have had the tendency to focus on financial performance, so the revenue functions, especially the ones that are, I would say traditionally associated to fee-for-service model. The front end aspect of it, the patient engagement aspect of it, utilization of patient portal and patient app. There's a lot of potential for growth, a lot of potential for much better and much broader utilization there. Anything around clinical decision support, which we all know has an impact on both care quality outcomes and financial outcomes, if there's really an under utilization of all of the capabilities associated to clinical decision support.

Abby Burns (08:00):
What's an example of a way that the EHR could support clinicians or provider organizations when it comes to clinical decision support that organizations aren't taking advantage of?

Carol Chouinard (08:11):
We're working with a number of health systems that have attempted really to bring standardization in how they provide care, and they've been using EHR as the way to keep best practices up to date. So on a weekly basis, they'll look at quality outcomes, they'll look at cost, and they'll update their workflow. What is the best practice, in terms of what to do with a patient? What is the best prescriptions we recommend, et cetera? There's an opportunity using EHR to deploy all of these best practices at the system level. So, we see a lot of systems who are still fragmented, who are still doing things differently from facilities to facilities. That is a big opportunity for care delivery improvement and financial improvement.

Abby Burns (08:56):
Yeah, if we have this sort of two-part definition, right? There are the functions that systems aren't turning on, and then there are the functions that are turned on but maybe aren't being used super effectively. What are some of the functionalities that fall into that second camp?

Jonathan Cooper (09:12):
For that answer, I would go into maybe just patient experience in general. So anything from appointment reminders to your digital front door, connecting your patient portal to your website, to taking Apple Pay through mobile app. There's so many different things that touch patient experience from both the clinical and revenue cycle side. I mean, frankly, all systems are working to increase volume every day and it all starts with the patient having easy, a good path to get care through your organization, and then also just that back and forth with the system.

Abby Burns (09:45):
Yeah, absolutely. In a few minutes, I want to talk about maybe some examples, what it looks like when systems are able to either turn these capabilities on or start using them to the top of their license. But first, I want your read on why organizations aren't currently able to take advantage of these functions. What's holding them back?

Jonathan Cooper (10:05):
Every organization is different, and how they plan for optimizing their system is different as well. So one, I do think that's probably a common misstep from a financial planning standpoint is not allocating funds regularly to the advancement of the system that you have. You spend a ton of capital and expenses to get live on said EHR, but then once you get live, it's really just the beginning of the journey. You have to then go through multiple upgrades a year. You're getting thousands of requests per year through ITSM tickets and do they want to invest in patient experience or clinical workflow standardization, or whatever it is. The reality of all those things do take resources away from your normal just keep the lights on support activities, but I do think you just have to have a very conscious roadmap and effort attributed to keeping your system at top of license.

Abby Burns (10:59):
Jonathan, I'm hearing a couple of things. One is, it's a prioritization question. How do you balance prioritizing, keeping your EMR functional and up to date? And then also, looking at what are the extras that we are, to your point earlier, maybe already paying for that we could be using more effectively? And then what are the trade-offs we make about spending the time, spending the resources to invest in building those things up? I think patient appointment reminders is a really good example that you've talked about in the past, which is it sounds like a pretty straightforward thing to turn on, but it's actually not that simple. Can you talk a little bit about that?

Jonathan Cooper (11:33):
You have to really go through a lot of decision points like, "Hey, per state, you can't just start texting your patients." You actually have to, they have to opt into it. Hey, how many hours in advance do you actually send the appointment reminder? And it sounds very elementary, but you have to work through those simple decisions and set up for anything, whether it's clinical, project, revenue cycle, or patient experience, whatever it may be, you really just have to take a very methodical approach to make sure it's successful.

Abby Burns (12:00):
And I could see how that could get overwhelming pretty quickly when you have just for a single functionality, so many trickle down questions, multiply that by all of the different things that the EMR could do, that could get out of hand pretty quickly.

Ty Aderhold (12:14):
I mean, the other thing I would bring in here, I think this is another case of underinvestment that often happens is on the training side of things, because there's so many users who need different level of training for how they should be interacting with the EHR or their ideal pathways with the EHR. And it's easy to think of that as a one-time thing and we're done, but best practice would be to continuously be providing some of that training and ensuring that those end users understand, what are the efficient processes turned on modules I can be taking advantage of to make my job easier and to be getting the value out of this tool?

Carol Chouinard (12:52):
Historical and cultural perspective as well, and maybe putting the hat of the CIO here, the industry has been really driven by national policies, right? National programs with incentives to adopt technology and the culture has been to first and foremost be compliant and be aligned with these policies. But from a technology perspective, there's only the 10 to 20% of the health systems at the top of the adoption curve are the ones that have more of a innovative culture, they're looking at what else they could be doing. And we're definitely seeing the change now with the introduction of gen AI capabilities, these are the same health systems who have been the first in looking at what are the potential initiatives that they could take on that they could be doing on their own or partnering with others, etc. So, we're seeing the same trend. The CIOs in general are more operators than actual entrepreneurs or innovators, and that's a big cultural aspect that we need to recognize exists in our industry.

Abby Burns (13:54):
And part of that is understanding, what do we lose out on? What are the costs of not doing all the things that you all are talking about? What are some of those costs that you see, maybe the short or the long-term implications of under utilizing the EHR?

Jonathan Cooper (14:12):
I think service for your car, if you delay it, you're eventually going to have to pay more in the long run. I would say that's true for EHRs as well. If you delay keeping your system up to date, taking upgrades, enhancements as you should during the course of the year, you say you do that for years on end, you're eventually going to get a very outdated system that needs to go through. Like Epic has a program called Refuel, if your system gets too far from foundation, you'll have to go through a Refuel project. It's almost like going through another implementation in a way.

Abby Burns (14:42):
Right, it sounds like it would be, again, a lot of time, resources, bandwidth that your executive team probably doesn't have.

Ty Aderhold (14:49):
The other thing I want to make sure we call out here is that I think there's also a cost to your future organizational strategy that is lost here if you are not considering your EHR staying up to date with your EHR. I think looking forward for organizations, the EHR has to be part of your broad C-suite level strategy conversations of where our organization is heading, and so if it's not there, that alone is an under utilization.

Abby Burns (15:24):
Ty, the other thing I think is important to mention there is from the long-term strategic perspective, even if you are not necessarily doing the type of work that the three of you are talking about, some of your competitors are, and there's the competitive angle to all of this as well.

Jonathan Cooper (15:38):
Agree, yeah. Honestly, even from a retention turnover standpoint, like your EHR functionality and how well it works for your employees is definitely something that's top of mind you have to keep a good perspective of. Say if one organization is using DAX CoPilot, then providers are using that heavily here and then another organization down the street, they aren't using AI capabilities in their clinical documentation. There's going to be a real competition to get the tech enabled, which helps your providers be more efficient.

Carol Chouinard (16:12):
Here in the Bay Area, we've had Kaiser Permanente who has been one of the initial big investors in EHRs that have really used their digital capabilities in every marketing campaign as a key differentiator, and now we're seeing all of their competitors not just here in the Bay Area but in all the markets where they compete, really having to keep up and/or compete with highly digitized and high importance of technologies in all aspects of both the provider experience. We are in the EHR conference seasons, they're all announcing a portfolio of new things that's bigger than what I think they had ever announced in the past. CIOs now are all gasping and asking themselves, why am I going to do what all of this?

Abby Burns (16:57):
Carol, maybe that's a good opportunity for us to look at the industry and ask the question of, what does good look like today in 2025 for systems to be able to take advantage of some of the innovations that are rapidly coming down the pike? How should provider organizations be thinking about their EHR?

Jonathan Cooper (17:18):
Going back to patient engagement example, if you need to increase volume, are you doing everything from an outreach perspective and with campaigns to get people in your door? If you're having revenue cycle issues, are you doing targeted projects to improve revenue cycle specific items? So I would just say what projects you're spending your attention and resources on, that's something that you have to be looking at daily and weekly and monthly to gauge where should be focusing.

Abby Burns (17:51):
Essentially what I'm hearing, Jonathan, is, you should be using your EHR as a strategic asset. So whatever your strategic priorities are, you should be mapping and prioritizing the investments that you make in your EHR to those priorities.

Jonathan Cooper (18:05):
Exactly. Couldn't have said it better.

Carol Chouinard (18:07):
Every day, we're getting involved in partnership where they want to either accelerate value-based care or they want to develop a certain service line or they want to be more integrated between acute care and ambulatory care. They very often forget the importance of having the EHR as the enabler of these strategies. So that is situation we see daily, health systems are still struggling with because a lot of times they fail to connect the dots between a transformation they are envisioning and the need to have the EHR folks coming along.

Abby Burns (18:44):
And I know this is something that you, to your point, Carol, you work with provider organizations every day on doing exactly that. I always think it's helpful when we're talking about pervasive challenges in the industry, to paint a picture of what it looks like when things go right, when systems are able to figure out how to take advantage of their EHR in the strategic way that you all are talking about. Do you have success stories that you can share with us?

Carol Chouinard (19:10):
There are definitely a couple of examples that when we look within our own family as part of the OptumCare Network, LCC Bolt and Reliant for example, are two organizations who have recognized really to have optimized the use of their EHRs, is enabling value-based care type programs. They are really sought after experts in the industry in these areas. And they got there really by hiring leaders that were not just operators, but that were open to use their EHRs in ways that were more or different than what other health systems would've been.

Abby Burns (19:48):
So Carol, what is the journey that they went on? What were some of the capabilities that they either turned on or started using more effectively, and what did it by them in their VBC journey?

Carol Chouinard (19:59):
In the context of population health and engaging and ruling patients in care management programs that are specific to their own situations, and using patient engagement tools really to actually engage their patients in their care at a level that most health systems have not so far. So, they've been combining really their care management capabilities and the patient engagement capabilities to achieve better results.

Abby Burns (20:24):
Yeah. What are some of those results that they've seen?

Carol Chouinard (20:27):
Just in terms of ME program performance, for example, they're in the top percentile in the industry. So, and they're definitely in the top five to 10% percentile within our own OptumCare Network.

Abby Burns (20:39):
The scale of the benefits that systems are able to reap can be pretty dramatic. I've seen instances, for example, there's a system in New York that implemented decision trees to support patient scheduling and they saw a 322% increase in self-scheduling, and they saw almost a 5% decrease in appointment cancellations. The same system looked at implementing automatic or self-pay payment plans that you all have mentioned before. They saw a 93% increase in outpatient collections and a 97% increase in hospital billing collections. Those are huge numbers that show the value proposition of, this isn't just a nice-to-do type of investment, it's hard work but you can really reap the rewards for the strategic goals that you set out for your organization.

(22:35):
One of the things I'm mindful of is, the pace of change of the technology here is so fast. You were referencing before, Epic just announced a whole new suite of AI enabled capabilities, Oracle announced something similar a few weeks ago. A lot of leaders I talk to are currently sitting in the wait and see camp before making some of these large investments that we're talking about. What do you say to the leaders that are in that camp?

Carol Chouinard (23:05):
I would argue, actually, that almost every health systems have their top 10 to top 100 list of potential initiatives or list of initiatives that are AI related. We are going from being in a maintenance mode where basically we keep upgrading our system at this fairly slow pace, and then we have this avalanche of new capabilities that is AI driven. And instead of the CIO or VPs making the pitch for additional resources, a lot of that pressure is coming from the board now. Board members are asking their leadership team, "What are we doing with AI? When are we going to be seeing the benefits?" So, they have triggered the development of these lists of top 10 to top 100. More and more what we're seeing is the introduction of this new consulting approach where basically we send a team and we can rapidly assess, where are the potential opportunities, and start implementing both small and bigger changes, taking advantage of these capabilities.

Abby Burns (24:06):
You're almost describing, Carol, more of a platform approach or a holistic approach, rather than point solution oriented strikes.

Carol Chouinard (24:13):
Or in consulting jargon, we would call it more of a squad team approach. Right? They're coming in, they're looking at the data, they're using metadata, they're assessing where the potential where opportunities are, and they're building a plan to go realize the benefits associated to these opportunities. The list of 10 to 100 really are getting put into a roadmap where we have dependencies, we have sequence, we have low hanging fruits, we have bigger, more transformative efforts. That is where health systems are right now, and obviously they all need the right level of governance to make sure that these initiatives are being done in a safe and fair way.

Abby Burns (24:50):
I'm hearing it's not a binary, either you're doing this or you're not. You're probably doing something. In fact, I think what you're telling me is you have to be doing something. It's about, how much are you doing? How big is the investment? And that is where we maybe see some variability. Ty, how does that sit with you?

Ty Aderhold (25:07):
I think that's exactly right. The other thing I would say is there are additional benefits to taking the steps that you are considering with your existing EHR vendor partner. You've already done a lot of vetting and you have built a lot of trust with this organization. That means there's less vetting when you're rolling out a new module than if you were going fully with a third party. It's also going to be fully integrated, and it's going to save you time and resources to be going with solutions that are native built into the EHR solution.

(25:45):
What that means though, is you have to be investing in those and you have to be up-to-date in order to move on those solutions. And so, it's not that you can sit around, wait, wait, wait, and then roll out everything. It's that if you are actively investing in your EHR over time, it'll set you up for success down the road as these solutions come into the platform, and everything we're seeing from the major EHR vendors is that they're going to continue to roll out these new AI solutions at a pretty rapid pace. And so, I think for organizations that are feeling like we do need to be moving in this space, we have a long list. One of the best ways to start tackling that list is through partnership and through turning on some of these modules within your EHR.

Abby Burns (26:32):
Really kind of an undertone to what I'm hearing from you all today is by keeping your EHR, not only baseline maintenance and up-to-date, but able to take advantage of the innovations that are coming fast and furious, it's really enabling your organization to be more nimble and more adaptable.

(26:51):
I want to close our conversation with maybe some practical guidance. What advice would you give provider leaders to become more sophisticated in the way they think about, engage with, leverage their EHR?

Ty Aderhold (27:06):
My advice is that more parts of your organization than the CIO and the CIO down line, need to be thinking about the EHR, actively engaging in conversations, understanding where the organization is today and where you can go. I think we need to move away from maybe the more historical model where that is often a silo with the CIO.

Jonathan Cooper (27:29):
Agree, yeah. I mean, the EHR really is an operational tool that has to be used at its highest capabilities. So I think if you don't already have a six-month plan, a year plan, further outlook like from a capabilities and things that you're turning on standpoint, you have to start with that at a minimum. And then also, make sure you have capital allocated to do these projects. That's where a lot of health systems that we connect with don't realize the investment needed to do a lot of these things, frankly. Work with your operations teams to understand where the gaps are and work with your finance counterparts to build a plan to put these things into action.

Carol Chouinard (28:06):
A couple of additional items. One is, really bringing the agile mentality to technology adoption, and that means having small team doing things fast and maybe in a less structured way than they were in the past.

(28:21):
Second is about thinking outside of the traditional health systems and thinking in terms of the ecosystem. The patient engagement tools are going to be industry-wide patient engagement tool, they're not going to be one health system. Most of the solutions associated to value-based care, care coordination, payer-provider interactions, are going to be tools that are going to be available throughout the industry not specific to a certain health system. So, if any IT stakeholders within health systems who are used to do projects within their own environment, they need to take a step back and look at the ecosystem more broadly.

Abby Burns (28:59):
Well, Ty, Carol, Jonathan, thank you for coming on Radio Advisory.

Carol Chouinard (29:04):
Thank you so much.

Jonathan Cooper (29:05):
Thank you.

Ty Aderhold (29:06):
Thanks for having us.

Abby Burns (29:10):
The data shows us that pretty much every organization could be using their EHR better, and the vast majority should be. That opens the question for you and your organization, what capabilities are we underusing or overlooking? And what opportunities are we leaving on the table as a result? These are the sorts of questions that Carol and Jonathan and their teams help provide our organizations with every day. If you want to get in touch with them, we can connect you. And as AI continues to transform the ways that EHRs can support your business, our Advisory Board research will continue to follow along, because remember, as always, we're here to help.

(30:05):
New episodes drop every Tuesday. If you like Radio Advisory, please share it with your networks, subscribe wherever you get your podcasts, and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by me, Abby Burns, as well as Rae Woods, Chloe Bakst, and Atticus Raasch. The episode was edited by Katy Anderson, with technical support provided by Dan Tayag, Chris Phelps, and Joe Shrum. Additional support was provided by Leanne Elston and Erin Collins. Special thanks to Ben Eisenhower. We'll see you next week.