How EHR Systems Fall Short of Meeting Value-based Care Requirements
Though EHRs facilitate medical record analysis and such other medical-legal processes, these systems have flaws. Five major shortcomings of EHRs are discussed in this article
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EHR implementation is expected to bring numerous important advantages in clinical settings. It can ensure easier access to clinical data, effective clinical workflow, fewer medical errors, efficient medical record organization and indexing, improved patient safety and excellent support for medical decision making. With the transition to value-based healthcare in the place of fee-forservice model, the important question is whether EHRs can help providers meet the challenging new requirements. In the value-based healthcare delivery model, healthcare providers including physicians and hospitals are reimbursed based on patient health outcomes. In the traditional fee-for-service model, providers are paid based on the amount of healthcare services they provide to patients. The HHS (Department of Health & Human Services) expects 50% of traditional payments to make the transition by 2018. However, a recent survey by Sage Growth Partners, a Baltimore-based business management consulting firm, does not paint a rosy picture regarding EHRs in the context of successful provision of value-based care. According to this study, around two-thirds or 64% of healthcare executives (including CIOs, CEOs, CNOs, CFOs and COOs) believe EHRs have failed to deliver many critical value-based care tools. Among those surveyed, 60 – 75% providers are looking for value-based care (VBC) solutions or PHM (Population Health Management) solutions outside their EHR. Though some providers did receive an ROI from their initial ventures into VBC, they found that most EHRs don’t have the vital capabilities that would enable them to undertake more advanced VBC initiatives. The survey identified five shortcomings of legacy electronic health record systems. ➢ EHRs do not cater primarily to the value-based care model: Built to automate a fee-for-service healthcare system, EHRs specialize in documenting patient encounters in office settings and converting those interactions into billing codes. Often, they do not capture the details needed to report for the Merit-based Incentive Payment system and alternative payment models including co-morbidities and progress against evidencebased care pathways.
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➢ EHR analytics are incomplete: In the value-based care model, providers have to benchmark and manage their patient population in terms of quality and cost. The volume of unstructured clinical data limits quality measure reporting from the EHR. Moreover, payer claims data that is necessary to calculate cost is totally absent. ➢ Poor interoperability: EHRs used at the point of care do not connect to emerging technologies that primary care physicians rely on to obtain an overall view of the patient’s condition and wellbeing. Custom interfaces, and new EHR fields and workflows are vital for integrating with other EHRs, lab information systems, care management applications, hospital feeds and pharmacies. ➢ EHRs cannot support broader and more complex fee-for-value workflows: Value-based care requires an interconnected workflow across all members of a care team, across all settings, and into the patient’s home. ➢ Patient portals do not equal patient engagement: Fee-for-service EHR portals made records of visits and secure communications available to patients. To meet value-based care objectives, EHR portals should enable not only a direct and interactive communication with patients to ensure progress consistent with care plans, but also uninterrupted, real-time access to address emergent symptoms and transitions in care. 70% of healthcare executives expressed their need for timely integration of clinical and financial data, and only 46% are happy with their existing capabilities. Other areas where EHRs fall short are care co-ordination and population health analytics. Though the electronic health record promised advantages such as lower costs, physician satisfaction, patient satisfaction, and improved population health management tools, the technology has failed to deliver these. Though healthcare executives understand that their EHR systems don’t meet the current requirements, most of them don’t intend to change their systems in the next three years. This may be because of the huge investment they have already made in their current EHRs which could top $50 million or$100 million for some health systems. The survey saw 65% of the respondents saying they are highly unlikely to switch. The only key area where most executives are satisfied with their current EHR systems is quality reporting.
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Value-based care has been introduced with the objectives of providing better care to patients, improving PHM strategies, and cutting healthcare costs. How can these objectives be achieved? With the pay for value healthcare reimbursement model, healthcare delivery becomes more systematized. EHR technology should support collaboration, and compile patient data that comes in from all sources. ➢ An HIPAA-compliant cloud-based data platform is vital, and it should be able to receive and store clinical data from all different sources such as EHRs, hospitals, insurance companies, pharmacies, labs, home health agencies, imaging centers, and from the patients themselves. ➢ The system should be able to identify each patient, organization, provider and other relevant details using reliable modern algorithms. The structure should be scalable and responsive. ➢ It must be possible to extract actionable data from this platform in real time. Data needed include aggregated data for individuals; population data must be available for value-based organizations, and de-identified data must be available to obtain insights and for research purposes. Though EHRs facilitate medical record analysis and such other medical-legal processes, these systems have flaws such as the ones highlighted above. Experts suggest that it is best for providers to look to other partners and start building the basic functionalities required for value-based care. Since VBC is not going to go away, healthcare providers must be proactive and create a value-based care roadmap. To meet the new requirements, they should adapt their technology tools accordingly.
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918-221-7791