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EHRs: The Facts, Future and Financials

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To comply with Meaningful Use initiatives, more than 95 percent of hospitals have implemented some form of electronic health record (EHR) system since 2011. Some have spent hundreds of thousands of dollars to simply comply and put a system in place, while others have spent millions – even billions – to tailor a program unique to their needs.

The truth is EHRs are expensive to plan for, implement, train and maintain. And today, only a few years after installing new systems, nearly 38 percent of CIOs are already investing in optimization projects to improve or upgrade their current EHR programs, making this the biggest area of spending in healthcare IT.

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While EHR provides many answers and solutions, it presents many questions, as well.

  • What is the ROI for this massive technology upgrade?
  • How will EHRs really improve healthcare for doctors and patients?
  • What does the future of EHRs look like?

These questions and others are being considered and tested at hospitals around the country. Here are some of the more innovative practices and uses for EHRs that may help hospitals and executives plan for the road ahead and get the most out of their EHR investment.

Big Data

Gathering big data from a patient population is one thing. Deciphering and applying that data to solve real-world health issues is another. Hospitals that are successfully doing this are finding it is a game-changer for helping patients, the community and their care outcomes.


  • Identifying at-risk or high-risk patients to help reduce readmission rates: This data analysis looks at EHR information, zip codes and socioeconomic data to assign patients a risk score. This can also include monitoring patients with numerous chronic diseases (diabetes, heart failure, cholesterol, cancer, etc.) in real-time to help reduce hospitalizations and drive down the cost of care.
  • Clinical trial enrollment: Using big data could help patients enroll in clinical trials that will help improve quality of care and enhance outcomes. For patients, this helps match them to clinical trials and have access to safety monitoring during the treatment. For healthcare providers/researchers, this means having the data they need to find patients for trials and evaluate therapies.


A technology that has been talked about and hypothesized for decades is now at its tipping point and gaining the attention of healthcare executives across the industry. More than 83 percent of telemedicine executives who were surveyed in 2017 by the American Telemedicine Association said they are likely to invest in telehealth this year. And more importantly, they see patient-centered healthcare and EHR interoperability as top advancements they are most excited about.

Using EHR systems to treat patients with telehealth can reduce the cost of the care for both patients and providers. This technology allows doctors to stay more organized, save time, log into the patient’s record from anywhere, and prescribe medication in real time.


  • Remote patient monitoring for issues such as weight gain in at-risk heart patients. One of the biggest readmission rates for heart attack patients occurs when they start to gain weight. By using monitoring devices, doctors can receive weight readings every day allowing them to track patients’ health and have an idea of risk for readmission.
  • Doctors, hospitals and nurses are using telemedicine to treat children at school. This type of visit includes a nurse at school using a telehealth cart with video capabilities and high-tech ear, nose and throat scopes to communicate with a pediatric doctor or hospital staff for a remote patient visit. Parents can video in on the visit from work, allowing children to stay in school, parents to stay at work and nurses/doctors to best assess the child. It also allows children who do not have access to health care to see a doctor without going to the ER, further reducing overall healthcare costs for hospitals and patients.
  • Treating at-risk patients with numerous chronic conditions remotely with telehealth. Hospitals can track at-risk patients through their physiological data remotely with biometric sensors. This data can track everything from weight and heart rate to blood pressure and oxygen saturation. This information allows the team to provide remote support and communicate with patients at important times. The pilot program at Banner Health reduced hospitalizations by 45 percent ‡ and drove down the overall cost of care by 27 percent.

Patient Engagement

Enabling patients to access their own EHRs has shown great promise in helping them take control and engage in their overall wellbeing as well as helping providers prioritize patients’ concerns. The practice of allowing patients to collaborate on EHR notes and help set the agenda for their appointment has shown to improve communication between the patient and the provider, increase patient satisfaction, decrease visit times for doctors and optimize the appointment.


  • A University of Washington pilot study of patients setting agendas for their appointments found that most patients and clinicians felt it enhanced their relationships, and most said they would like to continue the practice. Also, patients who created their own agenda for the visit gave the doctor a more collaborative feeling and increased patient engagement – a key component of accountable care organizations and patient-centered medical homes under the Affordable Care Act.
  • An OpenNotes study found that by reviewing their medical records and clinician notes, patients could spot safety concerns (usually pertaining to medication errors or misreported pre-existing health conditions), and many of the flagged reports were turned into medical record revisions. The findings suggest that patients can help identify mistakes and are eager to have accurate medical records on file.

These are only a few examples of how EHRs are being implemented and used by providers and patients. The truth is that this technology is constantly morphing and evolving to help improve healthcare treatments and outcomes across the board. Clearly, there is an inherent need for healthcare executives, doctors and patients to find more valuable uses for EHRs to enhance patient care, improve outcomes and save costs.

Furthermore, what’s most critical to the evolving world of EHRs is that you have the right partners at the table to help educate, train and effectively adapt this technology to your unique needs. This includes your vendors, IT department, doctors, nurses and users.

Finally, the financial burden of improving and updating your EHR system will be a consistent line item for the foreseeable future. Knowing how to budget and prepare for those costs is vital to the financial success of your organization. And working with a banking partner who understands the complex world of healthcare finance is just as important.

Richard Ziegner is director of healthcare banking at UMB Bank where he is responsible for leading the bank’s efforts in the healthcare sector and providing capital and financial solutions to healthcare providers. He can be reached at


Richard Ziegner is executive vice president and director of healthcare banking at UMB Bank where he is responsible for leading the bank’s efforts in the healthcare sector and providing capital and financial solutions to healthcare providers. He graduated from the University of Arizona in Tucson, Ariz. with a Bachelor of Science degree in finance and earned his Master of Business Administration degree from Northern Arizona University in Flagstaff, Ariz.

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UMB Insights: How Will Senior Housing Look in 2037?

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Millennials may be all the rage these days, but Baby Boomers are still making an enormous impact on the U.S. economy, particularly in the senior housing market. By 2050, the population of individuals aged 65 or older will grow from 40 to 89 million, an increase of 120 percent.

And as Americans age, where and how they will live becomes a more pressing issue – an issue that will have a significant impact on the economy, construction industry and banking sector over the next 20 years.

Where will Boomers live?

Although staying in their homes is almost universally preferred among Baby Boomers, many aging Americans will transition to multi-housing developments that provide some assistance and allow them to live as independently as possible. Others, especially those with medical disabilities, will seek housing in environments that provide more intensive nursing support and other assistance.

The average age of a resident in a senior housing facility is in the ’80s. With the leading edge of Baby Boomers just now turning 70, the need for additional senior housing units is expected to accelerate over the next few decades. In fact, between 2015 and 2020, all 50 states forecast growth in the number of 75-year-old+ households. The increase in senior housing will come from sectors such as Alzheimer’s and Memory Care facilities, independent living centers, assisted living facilities, skilled nursing facilities, continuing care retirement communities, home health care and hospice care.

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What will their housing look like?

It is a common rule of thumb in the industry that Baby Boomers will typically choose a newer, more modern and home-like facility versus an older institutional facility. Therefore, the industry has moved from an institutional feel to a more home-like atmosphere, including eliminating long hallways and nursing stations and replacing them with single rooms, private baths, large rehab spaces, smaller cafeterias, snack bars, beauty salons, theater rooms and much more. As a result, when new competition hits the market and consumers choose with their feet, it becomes much harder for older facilities to maintain the occupancy levels needed to ensure financial success.

How will their preferences affect the economy?

So, what does this mean for the general economy? It means that there are significant opportunities for contractors, developers and lenders that are experienced in senior housing to help owners modernize existing facilities or build new housing options for seniors. Construction for many new facilities is already underway or in the approval phases and financing continues to be readily available for developers and operators in this sector.

What are the risks?

On the flip side of this successful outlook, there are concerns and challenges that need to be monitored and addressed. Even though the senior housing industry is one of the fastest growing segments in the U.S. economy and there are many desirable lending and development opportunities, builders, developers and lenders must effectively mitigate the risks inherent in the industry.

Characteristics of the long-term care business require that successful participants maintain industry-specific knowledge and utilize best practices for each project. For the benefit of all parties involved, it is important that everyone tied to senior housing projects remain prudent and evaluate all risk related to each project. Doing so will mean a stronger economy with more housing options available for Baby Boomers of all ages.

Richard Ziegner is executive vice president and director of healthcare banking at UMB Bank where he is responsible for leading the bank’s efforts in the healthcare sector and providing capital and financial solutions to healthcare providers. He graduated from the University of Arizona in Tucson, Ariz. with a Bachelor of Science degree in finance and earned his Master of Business Administration degree from Northern Arizona University in Flagstaff, Ariz.

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