The next generation of EHRs will be mobile-first, voice-activated — and may not resemble modern medical records systems at all, health system CIOs told Becker’s.
As EHRs continue to evolve with more AI and voice functionality, IT leaders say they hope future platforms will move clinicians further away from the computer screen, reducing documentation burden and improving the patient experience.
“With the increased popularity of ambient listening, I want to see more functionality on mobile apps and less reliance on the 24-inch monitor,” said Will Landry, senior vice president and CIO of Baton Rouge, La.-based Franciscan Missionaries of Our Lady Health System.
Saad Chaudhry, chief digital and information officer of St. Louis-based SSM Health, compared modern EHRs to the early days of smartphones, which he said piece by piece have evolved to service the “near total automation of our lives — from the summoning of a physical, driverless vehicle with a push of a button on our screen to the robotic care-and-feeding of our pets based on the schedule we setup in an app.”
EHRs are similarly now at the “piecemeal” phase of AI before the technology subsumes — or even replaces — the platforms, he said.
“There will come a moment where most, if not all, EHR functions will be wrapped in AI, allowing us to interact with the systems in human language, completely masking the complexities that lie underneath,” he said.
“Eventually, an EHR as a standalone core system may even cease to exist, with all technology needs of a modern health system being met in a dynamic and fluid manner by an intelligent platform. And I predict that by the time we get there, it will feel like a natural step forward, rather than a massive leap.”
As EHRs evolve, IT executives will need to “get out of the way and not hold on to old ways of doing things,” said Denise Zabawski, CIO of Columbus, Ohio-based Nationwide Children’s Hospital. At the same time, they should ensure their health systems are factoring in both outcomes and risks when adopting emerging technologies like AI.
She expects EHR-based AI agents to assist providers, optimize the revenue cycle, work across systems and between organizations, and help patients manage their health records, save money, pay bills, schedule appointments and access home-based care.
“It will take building trust in the algorithms and agents to allow them to manage more complicated tasks,” she said. “Inevitably, AI will make it difficult for a patient to get to a real person. We need to make sure we don’t take the people completely out of the loop.”
Still, she doesn’t anticipate — or hope for — the disappearance of the traditional screen, keyboard and user interface, which she says are still important for medically complex patients and in the ICU.
“Integration of the burgeoning ambient listening technology has been a game changer for many providers, and expanding that tech for nurses and patient care technicians is a natural next step,” predicted Scott Arnold, executive vice president and chief digital and innovation officer of Tampa (Fla.) General Hospital. “More advanced automation and continued progress toward trusted, agentic artificial intelligence available within the workflow — inside the EHR — for team members seems like a logical development as well.”
The traditional IT concepts of “inputs and outputs” will become a thing of the past, said Chris Paravate, senior vice president and CIO of Gainesville, Ga.-based Northeast Georgia Health System
“Unencumbered by keyboards and searching for information, the information necessary to perform a task or make the next decision will be streamlined with efficient delivery,” he said. “Virtual agents will provide recommendations for precision care and thoughtful communications to both the patient and caregivers.”
More granular clinical decision support leveraging sensor data could also be on the way, said Evan Orenstein, MD, vice president of data and analytics and chief medical informatics officer at Children’s Healthcare of Atlanta.
“Ideally, novel EHRs would combine new information sources such as physiologic monitors, ambient audio and video, and wearables,” he said. “This ability to automate the collection of information from both literature and the real world would allow teams to identify care gaps more actively in all settings to optimize patient health and family and clinician decision-making.”
Reid Stephan, vice president and CIO of Boise, Idaho-based St. Luke’s Health System, said he hopes the next generation of EHRs will exist on a “truly cloud-native,” software-as-a-service basis and feature a “headless” architecture.
“No more ‘forklift upgrades’ or local customization drama,” he said. And “with APIs and services decoupled from the interface, we could tailor workflows to the clinician and patient without being locked into a rigid, one-size-fits-all interface.”
“This kind of flexibility would also mean fewer analysts are needed to maintain and configure the system, letting us shift resources toward innovation and insight rather than upkeep,” he added. “It’s time for our EHRs to evolve beyond their legacy architecture and embrace the agility of modern digital platforms.”
Simon Nazarian, executive vice president and chief digital and technology officer of Duarte, Calif.-based City of Hope, would like future EHRs to feature more AI-powered clinical intelligence, including predictive analytics for risk detection, voice-to-text charting, virtual assistants, and AI-driven triage and decision support.
“These things bring in a lot of time saved, by reducing charting and documentation,” he said. “They improve accuracy of diagnosis and reduce missed findings.”
In the years to come, EHRs hopefully will also automate coding and cut claims denials, he said. They will include integrated telehealth; mobile-first, intuitive interfaces; and “true interoperability,” with real-time access to labs and imaging. They will be “cloud native” and secure, with zero-trust architecture and advanced encryption.
“I would also push for a modular API ecosystem,” Mr. Nazarian said, “with EHR app stores where you can get plug-ins and third-party tools that can integrate into your workflow and … be able to incorporate custom tools for specialty use cases. Right now, as we stand, everybody’s kind of running a closed system, and I want to see that opened up in the next generation.”
Jeffrey Sturman, former senior vice president and chief digital information officer of Hollywood, Fla.-based Memorial Healthcare System, said he expects more applications beyond just AI and ambient listening to be embedded in EHRs.
“We will see the latest and greatest research incorporated into the direct functionality of EHRs, such as digital twins, physician-specialty ordering patterns and clinical guidelines, predictive modeling, care coordination and patient preferences,” he said. “The era of being data-driven will increase our ability to be more proactive in care and wellness.”
Dan Exley, interim chief information and innovation officer of San Diego-based Sharp HealthCare, foresees tomorrow’s EHRs of the future with “hospital of the future” technology — such as smart TVs and whiteboards and in-room speakers, microphones and cameras — to create a whole different healthcare experience than people are used to today.
“Success for me is when we look ahead a couple of years and clinicians walk into the care delivery space, and they are interacting with the patients and their families and are doing a voice-driven interaction with the EMR,” he said. “And the other information displays around the room are doing the hard work of providing the contextually relevant information in the background.”
He said certain specialists — namely pathologists and radiologists — will still need to rely on traditional computer workstations, but that much of healthcare will go mobile-first. He also envisions the next generation of EHRs — or even a post-EHR world — to be open to more competition because of the federal government’s investment in interoperability and data standards.
“I think it’s unlikely we’ll see Epic disrupted in any meaningful way for a variety of reasons, from the quality of the software they release, the user experience and the trust that organizations have with them. I’m not as sure about others, because they’ve really struggled with some things like quality, cost, customer relations, and those are the things that prime the pump for disruption.
“We have two to three market leaders at this point. If one or two of them starts to fall out — and I don’t assume that would be Epic falling out, but I don’t assume as much anymore that it’ll just be Epic picking up those accounts with continued growth — that’s where you’ll start to see some opportunity for those other EMR or other solution provider companies to get into the mix.”
AI agents in the EHR will also help shrink the size of the back-office healthcare workforce while meaningfully supporting front-line clinicians, Mr. Exley said.
“Healthcare is more exciting now than it’s been for me in the last 20-25 years,” he said. “We are really cooking on some really creative and advanced things that are actually hitting the real production, care delivery environment and making a difference, and that’s really exciting,” he said. “The next generation of EMRs is a big component of that, obviously, but there’s more going on alongside that too. So it’s a great time to be working on some really innovative, meaningful advancements in healthcare.”
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