The importance of an efficient EHR

Primary care practices must operate efficiently to be financially viable. Optimizing a primary care practice involves a number of factors, streamlining practice operations, reducing overhead, and taking advantage of technology. An efficient electronic health record (EHR) system is also critical for the successful operation of a primary care practice.

Patient medical records, care coordination, and treatment plans are all housed in their EHR. Traditionally, this documentation has been kept on paper in files lined up at the nurse’s station or elsewhere in the practice office. Finding information in paper files was incredibly inefficient in itself, involving time spent searching through paperwork and waiting on paper documentation from other healthcare providers caring for the patient.

An inefficient EHR also causes the physician to spend time searching for information that could be critical to the patient’s healthcare plan. Streamlining the process results in less time spent on the computer, more time spent with the patient, and a higher quality level of care for that patient.

An efficient EHR, such as Elation’s Clinical First EHR, will benefit the physician, the practice, and the patient by enabling the provider to document visit notes, order lab tests, e-prescribe, and write referrals in any order, all from the same screen. The need to enter and re-enter information, often found in an inefficient system, is reduced with prioritized automation throughout the workflow.

Additionally, as the Office of the National Coordinator for Health Information Technology (ONC) describes, an efficient EHR is important for the physician and the patient as it will:

  • Provide accurate, up-to-date, and complete information about patients at the point of care
  • Enable quick access to patient records for more coordinated, efficient care
  • Securely share electronic information with patients and other clinicians
  • Enable safer, more reliable prescribing
  • Enhance the privacy and security of patient data
  • Reduce costs through decreased paperwork, improved safety, reduced duplication of testing, and improved health.

Chris Anderson
March 31, 2020

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Why is there a decline in primary care visits?

Access to primary care has been shown to result in more positive healthcare outcomes and reduced costs. One study, conducted by Northwestern Medicine, concluded that “Americans with primary care received significantly more high-value healthcare — such as recommended cancer screenings and flu shots — and reported better patient experience and overall healthcare access, compared to those who don’t have primary care.” However, a separate research effort found that there has been a decline in primary care visits in recent years.

In a study involving the examination of insurance claims from 2008 to 2016 for adult health plan members aged 18 to 64 years, researchers discovered that “commercially insured adults have been visiting PCPs less often, and nearly one half had no PCP visits in a given year by 2016.” In fact, visits to primary care physicians declined by 24.2%, while the proportion of adults who had no primary care physician visits in a given year rose from 38.1% to 46.4% over the period studied.

Primary care is defined by the National Academies of Sciences, Engineering, and Medicine as “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.” The Office of Disease Prevention and Health Promotion (ODPHP) adds that access to primary care is associated with healthier outcomes. So why the decline in primary care visits?

ODPHP explains further that disparities in that access to healthcare definitely exist in the US. Obstacles that patients may face include:

  • Lack of health insurance
  • Language-related barriers
  • Disabilities
  • Inability to take time off from work for primary care appointments
  • Geographic and transportation barriers, particularly in rural areas
  • A shortage of primary care providers, particularly in rural areas

Many of these barriers intersect or overlap for patients who are not able to access primary care services.

A lack of health insurance has been found to decrease the use of preventive and primary care services. The ODPHP states that people who do not have health insurance may put off seeking care when they are ill or injured and are more likely to be hospitalized for chronic conditions, such as diabetes and hypertension, that could be treated by a primary care physician.

Issues with access in rural areas include the distance a patient may have to travel to be able to access primary care services. Rural communities tend to have fewer physicians than do urban areas and the shortage has been growing in recent years. Transportation barriers can keep patients from seeking preventive care such as vaccinations.

The researchers studying health insurance claims also theorize that the decline in primary care visits may be related to “decreased real or perceived visit needs, financial deterrents, and use of alternative sources of care” among patients who would otherwise seek out primary care.

Justin Egkan
March 11, 2020

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Responding to coronavirus concerns as a primary care physician

A virus that began in Wuhan City, Hubei Province, China, in December 2019 has spread internationally. The coronavirus, now referred to as COVID-19, has been confirmed in 57 people in the US, including those who were onboard a cruise ship that had previously been quarantined. Across the globe, more than 80,000 cases have been reported with a death toll of more than 2,700. Naturally, many of your primary care patients will be near panic stage as news continues to spread about the growing number of infections.

As a primary care physician, you will be faced with a multitude of questions and concerns from your patients. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have issued guidelines and dispelled myths for patients who are worried about the rapid spread of COVID-19.

  • Travel: The biggest concern is whether it is safe to travel on airlines and cruise ships, particularly to destinations where the virus is prevalent. The CDC is recommending that travelers avoid all nonessential travel to China and South Korea. Older adults and patients with chronic medical conditions should consider postponing nonessential travel to Italy, Japan, and Iran.
  • Face Masks: Images of virtually everyone in China and other infected countries wearing face masks to protect themselves have your patients worried about whether they should also wear a face mask. WHO recommends that you only need to wear a mask if you are taking care of a person who may be infected with COVID-19 or if you are coughing or sneezing yourself, to protect others from your possible infection.
  • Hand Washing: During flu season, it is always advisable to wash your hands frequently and thoroughly, with soap and water, to prevent the spread of germs. Washing hands is critical during the coronavirus outbreak. You should regularly and thoroughly clean your hands with an alcohol-based hand rub and then wash with soap and water to kill any viruses that may be on your hands.
  • Pneumonia Vaccines: At this time, researchers are still working on an effective vaccine for COVID-19. Vaccines against pneumonia, although highly recommended to protect your health, are not effective against the new coronavirus.
  • Hand Dryers, Alcohol Sprays, and Other Myths: Unfortunately, when a virus such as COVID-19 continues to spread and infect thousands of people across the globe, your patients will hear many words of advice that just aren’t true. As a primary care physician, you can guide your patients to a better understanding of the facts:
    • Hand dryers do not kill the coronavirus
    • UV lamps should be not used in an attempt to sterilize hands or other areas of the skin
    • Spraying alcohol or chlorine over the body will not kill viruses that already exist within the body
    • Domestic pets such as dogs or cats are not infected and cannot transmit the new coronavirus
    • Regularly rinsing the nose with saline will not protect you from being infected with COVID-19.

While people of all ages can be infected, older people and people with chronic or pre-existing conditions are more vulnerable to becoming ill. As a primary care physician, you can reassure your patients who have concerns about the new coronavirus by presenting the facts and dispelling the myths. Patients should take the necessary precautions to avoid being infected, just as they would for any virus, including following good hand hygiene and good respiratory hygiene.

Justin Egkan
March 3, 2020

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The Primary Care Quarterback: How great primary care means better care management

In the game of football, the quarterback’s role is to coordinate and act as the leader of the offense. The quarterback works with other team members and coaches to produce the best possible play each time, so that the team can reach the goal at the end of the field. In healthcare, the primary care physician plays the role of quarterback. Your goal is a positive outcome for your patients, through better primary care and better care management.

It all starts with great primary care. Research has shown that the quality of healthcare, including the costs incurred, is strongly linked to the availability of a primary care physician for the patient. In fact, it has been found that patients with “access to a regular primary care physician have lower overall health care costs than those without one, and health outcomes improve.” Further, in “areas of the country where there are more primary care providers per person, death rates for cancer, heart disease, and stroke are lower and people are less likely to require hospitalization.”

The goals of care management include reducing those hospitalizations and reducing the costs of healthcare overall. Primary care can achieve these goals, as well as provide higher quality care to patients, by coordinating their care appropriately.

A study published in the Annals of Family Medicine found a number of attributes of high-value primary care practices that cohered into three themes:

  • Risk-stratified care management
  • Care selection of specialists
  • Coordination of care

These three areas “reflect physician recognition of the need for ‘care traffic control’ to help patients with complex conditions or treatment plans” navigate the healthcare system for better outcomes.

The study found that high-value primary care resulted in:

  • Decision support for evidence-based medicine. Primary care teams ensure that patients receive evidence-based care and treatment, noting guideline reminders in the patient’s electronic health records (EHRs) for other physicians.
  • Careful selection of specialists. Developing relationships with specialty providers whom the primary care physician trusts and continuing to communicate with those providers are critical to quality outcomes for the patient.
  • Standing orders and protocols. With protocols for uncomplicated illnesses and disease management, the primary care team can use standardized workflows for patient care.
  • Balanced compensation. Value-based care accounts for “care quality, patient experience, resource use,” and primary care practice improvement activities.
  • Care coordination. The primary care team monitors patients, including visits to specialty providers, labs, and diagnostic tests, to ensure patients complete their referrals, schedule follow-up appointments, and adhere to treatment and medication instructions.
  • Risk-stratified care management. Through the delivery of quality primary care, each patient receives care based on his or her unique needs, whether that involves office visits, monitoring and guidance provided by a care manager, or communication after the visit to clarify diagnoses and care instructions.

Justin Egkan
February 20, 2020

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Primary care physicians guide to 2020

The healthcare landscape for primary care physicians will include a number of rule updates and policy changes in 2020. Reimbursement rates and interoperability are issues to watch, as well as an increased emphasis on value-based care. Regulations such as Stark’s Law are being rewritten and strategies such as care management are becoming more important to the primary care physician’s practice.

CMS Updates

Rules that modify how physicians get paid for evaluation and management (E/M) services have been revised for 2020. The Centers for Medicare & Medicaid Services (CMS) has finalized the physician fee schedule for 2020, targeting primary care physicians and encouraging them to spend more time coordinating care for patients. CMS hopes these updates will:

  • Help address social determinants of health affecting primary care physicians’ patients
  • Increase patient adherence to treatment
  • Improve continuity of care.

In regard to social determinants of health, CMS Administrator Seema Verma believes increased payments will help providers:

  • Better coordinate care
  • Improve health outcomes
  • Cut spending.

For primary care physicians participating in the Merit-based Incentive Payment System (MIPS), the minimum score needed to avoid a penalty increases from 30 to 45 points in 2020. The score affects 2022 payments, with the maximum penalty also being increased, from 7% to 9%. In addition, while CMS had proposed setting the 2020 high-performer threshold at 80, the final rule actually raised that threshold to 85 points.

Stark Law

The Stark Law was enacted in 1989 to prevent physicians from referring Medicare or Medicaid patients to healthcare services from which the physician or a member of the physician’s family would profit financially. Regulations and exceptions have been added to the Stark Law in the years since and it is currently a vast collection of regulations and statutes. In 2020, CMS will look at making significant changes to the law, which was named after Rep. Pete Stark, a California Democrat.

More than likely, debate over the law’s current relevance and role in managed care will take place throughout 2020. CMS Administrator Verma says that the law is “outdated,” as preventing inappropriate financial incentives does not make as much sense in today’s managed care and value-based care systems as it did in the fee-for-service system.

Interoperability

Interoperability allows the electronic sharing of patient information between different EHR systems and healthcare providers, improving the ease with which doctors can provide care to their patients and patients can move in and out of different care facilities.

The US Department of Health and Human Services (HHS) is focused on hastening the adoption of interoperable electronic health records (EHRs) in 2020. The Interoperability and Patient Access proposed rule requires all Medicare, Medicaid, and federal exchange plans to share claims data electronically with healthcare enrollees. The rule is expected to take effect in 2020.

Elation’s Collaborative Health Record (CHR) aims at facilitating cross-communication between providers. The CHR is a centralized dashboard with a patient’s story, notes, and test results, managed by all the physicians treating your patient. All you have to do is open your patient’s longitudinal record and all of the information is right in front of you, allowing you to make more informed decisions about your patient’s health.

Justin Egkan
February 18, 2020

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Explaining the primary care shortage and the importance of primary care

As the population ages and needs more primary care services, the shortage of primary care physicians to treat those patients continues to increase. According to the Association of American Medical Colleges (AAMC), “there will be a shortage of between 21,100 and 55,200 primary care physicians by 2032.” In its recent publication, Myths and Facts: The Physician Shortage, the AAMC dispels the myth that the shortage is a result of fewer medical students choosing primary care and instead focuses on the situation being caused by more older patients needing that primary care access.

AAMC’s findings are the result of a survey conducted by the Life Science division of IHS Markit and reported in The Complexities of Physician Supply and Demand: Projections from 2017-2032. The fifth annual study includes “scenarios that have been refined and updated based on input from stakeholders, and new modeling that examines the impact of emerging health care delivery trends on physician shortages.”

In addressing the results of the survey, AAMC President and CEO Darrell G. Kirch, MD, explains that “The nation’s population is growing and aging, and as we continue to address population health goals like reducing obesity and tobacco use, more Americans will live longer lives. These factors and others mean we will need more doctors. Even with new ways of delivering care, America’s doctor shortage continues to remain real and significant.”

The physician shortage is not necessarily a result of fewer primary care physicians but rather is a result of more demand from patients who are growing older and who need more quality primary care services. Baby Boomers, those born between 1946 and 1964, are turning 65 “by the thousands” and are becoming more vigilant about their healthcare. The eldest members of this generation are also signing up for Medicare “by the thousands.”

Quality primary care has been shown to reduce the frequency of emergency room visits and hospitalizations. As the population ages, more patients are experiencing health conditions that can be better managed by a primary care physician. Preventive care becomes particularly important for older patients as well.

AAMC suggests that “Fixing the doctor shortage will require training a few thousand more doctors a year, working on new delivery models and technologies, and receiving help from nonphysician providers.”

Justin Egkan
February 5, 2020

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How to find the best EHR for your primary care practice

Electronic health records (EHRs) can ensure your patients’ medical information is accessible, accurate, and secure. The ability to input data into a patient’s EHR can save your practice from potential duplication and errors, as well as the delay created in using paper records and referrals. The question for many primary care physicians, though, is which EHR solution is best for the practice based on your specific needs.

All EHRs must offer conform to security requirements as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Patient data must be protected and accessible only by those providers who have the patient’s express permission. In addition to HIPAA regulations, electronic data is protected under the Health Information Technology for Economic and Clinical Health (HITECH) Act. HITECH was signed into law in 2009, as part of the American Recovery and Reinvestment Act (ARRA), to promote the adoption and meaningful use of health information technology.

Beyond the legal requirements, EHR solutions differ in terms of features, training, and customer support. One consideration for your primary care practice is whether you prefer to have EHRs housed on an internal service or on the cloud. Cloud-based EHR systems solve many of the issues that practices may be worried about when choosing to adopt an EHR system. In server-based EHR systems, thousands of dollars are often spent in order to install and implement a server, hardware, and software. Additionally, regular maintenance and management from a local IT department is needed. Cloud-based EHR systems are already established by the EHR provider, meaning the expense of money and time diminishes dramatically.

To comply with Centers for Medicare & Medicaid Services (CMS) requirements, you may need a certified EHR. As CMS states, “CEHRT gives assurance … that an EHR system or module offers the necessary technological capability, functionality, and security to help them meet the meaningful use criteria. Certification also helps health care providers and patients be confident that the electronic health IT products and systems they use are secure, can maintain data confidentially, and can work with other systems to share information.”

A vendor’s ability and willingness to assist with implementation and training and then provide customer support when you need it are also key factors to review when searching for the best EHR for your primary care practice. At Elation Health, we know that your time is valuable. That’s why we designed our clinical first, cloud-based EHR  to take less than an hour to learn. We’ll even migrate your previous patient data across for free. In addition, with Elation’s extraordinary 24/7 support, you’ll get help from our team of dedicated user success specialists within 30 minutes or less – 365 days a year.

Justin Egkan
January 10, 2020

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It’s time for primary care physicians to rethink technology in their exam rooms

Primary care physicians want more time to focus on their patients during each visit. While technology has been designed to help them do just that, many providers find that learning and managing the technology in the exam room is potentially cumbersome, time-consuming, and even distracting for them and their patients. Primary care physicians can, and should, rethink the use of technology in their exam rooms, to find ways that it can actually help them spend more time developing that critical relationship with their patients.

Electronic health records (EHRs), in particular, are designed to help the primary care physician become more efficient, creating more time for focusing on the patient. Tom Schwieterman, MD, Midmark Vice President of Clinical Affairs and Chief Medical Officer, writing in Physicians Practice, offers three suggestions for physicians to “help ensure a pleasant in-room experience when introducing new technology at the point of care.”

Limit electronic barriers. Seemingly counterintuitive to the argument for rethinking the use of technology, Dr. Schwieterman suggests that in-room electronic devices should be virtually invisible. He suggests that “Clicks of all types need to be reduced (or eliminated), data flows from connected devices need to be automated and the user interface must be optimized for efficiency.”

Make data entry seamless. Again, clicks need to be minimal when using technology in the exam room. He adds that “Results from vital signs measurements should find their way automatically into the patient record. Data entry templates need to be painstakingly optimized to ensure the workflow is as efficient as possible.”

Choose exam room equipment that is designed, or redesigned, with modern digital technologies in mind. Primary care physicians should consider the visual design of the exam room. The provider’s computer should be positioned so that the physician faces the patient while inputting data or reviewing the patient’s medical record. Dr. Schwieterman emphasizes that “EHR technology impacts virtually every step in the care journey,” and as a result, “the exam room layout needs to consider how EHR attributes can be optimized for workflow considerations.”

Greg Miller
December 9, 2019

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What is high-value care?

The concept of value is not one that can be measured precisely. Value may mean different things to different people, depending on their situation and perspective. A conversation with two physicians conducted by AAFP recently helps clarify what high-value care means to providers and their patients.

The conversation with Kyle Leggott, M.D., a family physician doing a fellowship in health politics and policy at the University of Colorado, and Allison Edwards, M.D., a direct primary care practice owner in Kansas City, Kan., was conducted in response to a study published in the American Journal of Managed Care (AJMC) that “found that getting rid of cost-sharing for primary care actually saves money and reduces utilization.” An editorial followed the article, in which the writer asserted that unlimited, unrestricted access to primary care would lead to increased unnecessary care.

Dr. Leggott and Dr. Edwards pointed out that the value of care stems from the relationship that the physician and patient are able to establish as well as the decisions made collaboratively by provider and patient rather than by third-party entities. Dr. Leggott commented that “A patient’s access to a family physician shouldn’t increase costs if the patient and physician are working together to spend health care dollars appropriately.”

Dr. Edwards further explained that “high-value” care may be seen differently by different people. She gave an example of a patient who was prescribed a very expensive medication that he was not able to take as an outpatient because of the cost. The prescription was seen as high value based on its evidence-based success in treating a certain condition and reducing readmission; however, to the patient who could not afford the drug, the prescription was essentially worthless.

Understanding the cost of treatment and prescriptions is critical for the provider and the patient, to determine what truly will be high-value care for that particular patient. The physician who knows the patient well enough to recognize what is feasible and reasonable for that patient will be more successful in providing that high-value care. As Dr. Edwards emphasizes, “The discussion about value-based care is incredibly nuanced because it requires that we be rigid with our definition of value, and in reality, life doesn’t play out that way.”

Damien Neuman
November 18, 2019

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What is a Federally Qualified Health Center (FQHC)?

The Federally Qualified Health Center (FQHC) is focused on providing primary care to patients in underserved areas that may not have insurance or the ability to pay their medical bills. The Centers receive funding from the Health Resources & Services Administration (HRSA), an agency of the Department of Health and Human Services (DHHS), that is the “primary federal agency for improving health care to people who are geographically isolated, economically or medically vulnerable.”

FQHCs are also known as Community Health Centers and can be found in every state in the US as well as in the US territories. In fact, there are “nearly 1,400 health center organizations with more than 11,000 locations in urban, suburban and rural communities across the country.” FQHCs must meet a stringent set of requirements to be able to meet the needs of the underserved in their communities and receive funding from the HRSA.

FQHCs:

  • Qualify for funding under Section 330 of the Public Health Service Act (PHS).
  • Qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits (the FQHC benefit under Medicare was added effective October 1, 1991)
  • Serve an underserved area or population
  • Offer a sliding fee scale
  • Provide comprehensive services (either on-site or by arrangement with another provider), including:
    • Preventive health services
    • Dental services
    • Mental health and substance abuse services
    • Transportation services necessary for adequate patient care
    • Hospital and specialty care
  • Have an ongoing quality assurance program
  • Have a governing board of directors that must include FQHC as a majority of the members

Specifically, FQHC services include:

  • Physician services
  • Services and supplies incident to the services of physicians
  • Nurse practitioner (NP), physician assistant (PA), certified nurse-midwife (CNM), clinical psychologist (CP), and clinical social worker (CSW) services
  • Services and supplies incident to the services of NPs, PAs, CNMs, CPs, and CSWs
  • Medicare Part B-covered drugs furnished by and incident to services of an FQHC practitioner
  • Visiting nurse services to the homebound in an area where CMS determined there is a shortage of home health agencies
  • Outpatient diabetes self-management training (DSMT) and medical nutrition therapy (MNT) for patients with diabetes or renal disease furnished by qualified practitioners of DSMT and MNT

Damien Neuman
November 1, 2019

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