Emerging from EHR purgatory through value-based reimbursement

As an independent physician using an EHR system, do you find that you are spending more time on the computer than with your patients? EHR systems are theoretically designed to enable you to spend less time on charting and billing so you will have more face-to-face time with patients. However, a reimbursement structure that rewards quantity over quality may be challenging that EHR design theory. Writing in the New England Journal of Medicine, Allan H. Goroll, MD, an internist at Boston-based Massachusetts General Hospital, posits that the “underlying mode of physician payment” is the driving force toward “EHR purgatory.” Dr. Goroll goes on to explain that “delivery from EHR purgatory may require a fundamental change in the way we pay clinicians: moving from rewarding processes to rewarding outcomes.” Value-based reimbursement shifts the focus back to the quality of patient care and shifts the EHR focus back to managing data on patient visits, lab results, and the patient’s healthcare plan. The EHR must also promote communication between patient and physician as well as between a patient’s multiple providers. Elation’s Clinical First EHR enables independent physicians to spend their time focusing on patient care rather than on tedious and often repetitious data input. At Elation, we recognize that entering and re-entering information has remained a time-intensive and cumbersome part of adopting electronic health records. Elation reduces this need by prioritizing automation throughout the workflow. Clinical First is a commitment to building a provider-centric Clinical EHR that exists at the nexus of the clinical workflow, supports the physician-patient relationship, and drives outstanding patient outcomes. Independent physicians should be able to spend more time engaging with their patients during visits and during follow-up communication and less time in EHR purgatory. We understand that, as an independent physician, you are concerned about your patients’ care quality. You need to spend less time on the paperwork and on the computer and more time doing what you do best, providing value-based patient care.

Parker Nieves

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Using EHRs to reduce stroke risk

The American Heart Association states that 800,000 people experience a stroke in the United States each year. Of those, approximately 130,000 people die. Preventing or reducing the risk of stroke is crucial for independent physicians who are concerned with the quality of their patients’ healthcare. How can electronic health records (EHRs) help these physicians as they focus on helping their patients? Researchers in California are studying the impact EHRs can have for physicians who are able to review a patient’s medical records for signs of a second stroke. Patients who have had one stroke may have an irregular heart beat called atrial fibrillation, which has been identified as a risk factor for a second stroke. The researchers have found that if physicians using EHRs can “identify the stroke patients who are most likely to experience atrial fibrillation, they could start treatments that would help prevent a second stroke.” Stroke patients are monitored while they are in the hospital and, often, after their discharge. Not all patients require or receive such monitoring. Reviewing a patient’s medical records in an EHR can provide the independent physician the information needed to determine whether a stroke patient is in danger of experiencing additional strokes, without the need for 24/7 monitoring. Understanding the clinical data contained in the EHR can actually help the physician determine which patients need that constant monitoring and which can be assessed based on their medical records. The study assigned risk factors and then categorized patients into risk groups based on those categories. Risk factors for stroke that are known to be “age, obesity, congestive heart failure, hypertension, coronary artery disease, peripheral vascular disease and disease of the heart valves — are the basis of a scoring system that assigns patients to one of three risk groups.” Elation’s Clinical First EHR enables independent physicians to input and review the data that can be so crucial in predicting and reducing stroke. Our EHR tool also provides the communication tool that can play a critical role in patient-physician communication, which can also help with awareness and prevention.

Parker Nieves

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The importance of usability in our healthcare system

Electronic health record (EHR) systems offer helpful functions for independent physicians, including the ability to manage patient visit notes and coordinate with other providers. However, the tool has to be usable if it is to serve its intended purpose and be valuable to those physicians. The International Organization for Standardization (ISO) has developed a standard definition of usability as “the effectiveness, efficiency and satisfaction with which specified users achieve specified goals in particular environments.” In other words, the tool must be effective in achieving the physician’s goals in using it, be an efficient way to achieve those goals, and provide the physician with the satisfaction that it has served its function in reaching those specific goals. Why is usability important? At the recent Electronic Health Records Association (EHRA) Usability Summit, it was pointed out that usability does not just affect the physician in an independent practice. Often, a medical assistant or billing staff member will also use the EHR to add or manage patient information. Patient and physician use of the communication feature also requires usability on the patient’s end. All of these individuals must be able to use the system effectively for the process to flow seamlessly. Usability is also an issue where the security of patient data is concerned. When data is shared among multiple physicians, laboratories, and healthcare facilities, each of those providers must be able to use the tool appropriately to prevent a breach of confidentiality. The need for increased security levels becomes a greater concern as the use of technology increases. The importance of usability is reflected in the need to provide quality care efficiently and effectively using such advanced tools as EHRs. Elation’s philosophy is focused on building a technology platform that doctors and patients use because they want to use it. The usability of the Elation EHR system builds trust, improves the quality of care, and enables the independent physician to be more productive and effective.

David Burke

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Technology driven value-based care

The shift to value-based payments from fee-for-service payments is essentially a shift to quality from quantity. No longer will physicians be paid for each service or each visit. The trending emphasis is on providing value-based primary care that is focused on the quality of patient outcomes rather than the number of patient visits. How can technology help physicians deliver on the promise of value-based care? Financially, the independent physician will need to be prepared for the new fee structure, according to a recent article in Revenue Cycle eLearning. With a “true outcomes-driven model, the bundled payment model will require the payer to look ahead and pay providers a single, pre-determined price for an entire encounter at the time of service delivery.” The single payment will include all related services and follow-up visits. Adopting an EHR system will become essential to managing value-based primary care for optimum patient and financial outcomes. Effective technology will be an essential tool for the independent physician in driving not only financial solvency but also patient health. As the article notes, “an EHR will serve as the underlying system for everything moving forward.” An EHR system enables the independent physician to manage patient care as well as the practice itself, more efficiently and effectively. Having access to a patient’s complete medical record, including information from other providers, labs, and healthcare facilities, enables the independent physician to develop and implement a more complete overall picture of the patient’s care plan. Redundancies - and the associated costs - are reduced or eliminated. Elation’s philosophy from the start has been to help independent physicians provide value-based primary care that benefits the patient and the practice. We recognize the enormous chasm between the world of policy and payers and the world of the front-line physician. We have built our solutions with a mission to strengthen the relationship between patients and physicians, and enable phenomenal care for everyone. Elation’s EHR system can help transform value-based primary care.

Parker Nieves

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EHR use expected to increase regardless of whether the ACA is repealed

The Affordable Care Act (ACA) continues to be threatened with repeal and replacement. Even as the new bills are debated and delayed, however, many aspects of healthcare will continue to move forward. Advances in technology, particularly in the use of electronic health records (EHR), are actually predicted to increase as they positively impact improvements in patient diagnosis and treatment. The Harvard Business Review (HBR) has identified three aspects of healthcare that are not affected by the deliberations over the ACA: The population will continue to age, the article points out, and aging patients will need expanded health care delivery. The research and discoveries that impact the life sciences will continue in healthcare laboratories. The use of technology that has “become a pervasive element across the health care system, with a major impact on diagnosis, treatment, and communications,” will continue to increase. The HBR article points out that the use of EHR has grown tremendously over the past few years, from one in five practicing physicians using an EHR in 2004, to the nearly nine in ten who use the tool today. EHRs are important instruments in the independent physician’s practice, used to “guide treatment, assess outcomes, and measure quality of care.” In addition, coordinated care driven by EHR interoperability will become increasingly important to the treatment of the aging population. Life sciences research also continues to be impacted by electronic patient data. The increase in discoveries in the laboratory is “being driven by two major trends: the availability of personal health data, and the plummeting cost of integrating massive health data sets in the cloud.” Technology will play a significant role in healthcare delivery now and in the future, regardless of political debates over healthcare insurance and payment options. Advances in EHR systems, particularly in interoperability between the systems, will continue to fuel advances in improving patient outcomes and in the overall quality of healthcare.

David Burke

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Prominent CIO predicts EHRs are headed in a more patient-centric direction

Healthcare is all about the patients. Electronic health records (EHRs) are designed to maintain those patients’ medical data in a seamless, secure environment. EHRs are also intended to provide a platform through which providers can communicate with each other and with their patients about their patients’ care. In a recent blog post, John D. Halamka, MD, MS, Chief Information Officer of Beth Israel Deaconess Medical Center, describes what he envisions as a “transition from EHR 1.0 to EHR 2.0” as EHRs move toward being more patient-centric. Dr. Halamka, who is also Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician predicts that certain trends will impact the future of EHRs: Fewer government mandates. EHRs will be able to focus more on results rather than simply recording activity. Team-based care. Independent physicians will rely on staff and other physicians to assist with inputting data and prioritize patient messaging. Value-based purchasing. The use of the EHR is moving away from fee-for-service payments and toward patient satisfaction. The next generation of EHRs “should include the functionality necessary to document care plans, variation from those plans, and outcomes reported from patient-generated healthcare data.” Usability. Patients as well as physicians should have access to improved EHR usability, to more properly and actively manage their care. Consumer driven. The patient needs to be included as an active participant in the care management process. Patient portals within the EHR should enable the patient to schedule appointments electronically, interact with physicians, and become “an equal member of the care team, providing them with care navigation tools.” EHRs are headed in a more patient-centric direction, in a move toward supporting “teams of caregivers focused on value while treating patients as customers.”

Tyler Comstock

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Can electronic health records predict a patient’s future health?

Researchers at the University of Chicago are examining whether electronic health records (EHRs) can be used to make healthcare predictions. The researchers at UC Medicine believe that, by extracting information from a patient’s electronic health records, they can “create predictive models that could help prevent unplanned hospital readmissions, avoid costly complications and save lives.” The research project is a collaborative effort of UChicago Medicine, Stanford, and the University of California, San Francisco, with Google’s machine-learning research team. An important aspect of this research is the ability to extract information from health records that are electronically maintained. When a patient’s data is stored and managed using a tool such as Elation’s Clinical First EHR, the data is accessible not only for patient care, but also to be used to improve a patient’s future health. A Clinical First EHR enables the independent primary care physician to holistically evaluate patient population with a longitudinal record that trends vitals and lab values over time. Understanding a patient’s current situation and gathering information that helps in predicting future trends can make a significant difference in the patient’s care management plan. Communicating this information to the patient and to specialty providers caring for the patient is also a vital piece in the overall collaborative care picture. The UC Medicine study is critical to the future of healthcare in general, given the startling statistics described in a recent Science Life article on the research project. Specifically, each year in the United States: Unplanned hospital readmissions cost as much as $17 billion The CDC estimates that health care-associated infections lead to 99,000 deaths Problems with medications cause more than 770,000 injuries and deaths Globally, 43 million people a year worldwide are affected by medical error. Elation’s philosophy has always been focused on our mission of enabling phenomenal care for everyone. Our Clinical First EHR can help manage patient care more effectively now and contribute to healthcare predictions that will save lives.

Gabby Marquez

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Elements of an ideal EHR

An electronic health record (EHR) system that is poorly designed may actually require more of an independent physician’s time and focus than was intended by the advance in technology. What do independent physicians really want to see in their EHR system, to ensure it contributes to the efficiency and effectiveness of their practice? What are some of the elements of a perfect EHR for physicians? The American Medical Association (AMA) conducted a study of physicians using EHR in 2016 and came up with a list of features that they believe should be part of an effective EHR system, based on the feedback of those providers. The EHR system should: Enhance physicians’ ability to provide high-quality patient care Support team-based care Promote care coordination Elations’ clinical EHR for independent physicians addresses all of these concerns. In fact, our focus has always been on developing the right tools that will enable independent physicians to provide the highest quality patient care, without being bogged down in administrative paperwork. At Elation, we are also focused on care coordination and have developed the Collaborative Health Record with the goal of enabling the independent physician to automatically collaborate with a patient’s other providers. Additionally, the AMA recommends that EHR systems should “expedite user input into product design and post-implementation feedback.” At Elation, one of the key features of our clinical EHR for independent physicians is that we encourage users to provide their input so we can make improvement based on their feedback. Jesse M. Ehrenfeld, MD, MPH, an associate professor of anesthesiology, surgery, biomedical informatics and health policy at Vanderbilt University School of Medicine and a member of the AMA board, stated that physicians “want tools that help us provide high-quality care and make the process of care easier and more efficient.” That’s exactly what we want at Elation as well. We designed our clinical EHR for independent physicians to enable physicians to focus more fully on their patient outcomes, through the coordination of the highest quality care. Want to learn more about why Elation is truly the ideal EHR for independent physicians?

Parker Nieves

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