The Future of EHR's (Part 2)

The first part of this series of blogs began to question the use, practicality, and the future of Electronic Health Records (EHRs). We purposely separated EHRs into two distinct categories for purposes of this discussion: the first category are EHRs designed to primarily drive and produce documentation to support a medical billing transaction, and the second category are those designed and driven to support high-end specialty practices.

In a future series of blogs, we will discuss why nearly 70% penetration of EHRs into the U.S. healthcare system still have not achieved measurable improvements in quality of care or created new efficiencies. On the contrary, we believe that documentation and transparency has gotten worse and that physician efficiency has been reduced. We will discuss the metrics on these points in this future series of blogs and point out what we believe to be the “cures.”

However, in this current series of blogs, we will be addressing a recent position paper created, approved and released by the Board of Regents of the American College of Physicians (ACP). To state it mildly, this 23-page report and appendix is a loud cry for help from a profession and an industry in trouble. The title of the report is, “Putting Patients First by Reducing Administrative Task in Health Care: a Position Paper of the American College of Physicians.” This position paper builds on work previously done by the ACP initiative of 2015 called, “Patients Before Paperwork.”

This new report has seven public policy statements and recommendations. The ACP report is very critical of building and compounding government regulations and mandates, and openly calling into question the validity and correlation of reporting actual quality of care metrics.

The relevance of this report to our blog is the near indictment of current EHRs in the United States and the health information industry. You will find that the report paints a clear call for innovation, reduction of costs, and the need for better interaction between medical care providers.

The ACP acknowledges the challenging reporting requirements by the Affordable Care Act (ACA), the Health Insurance Portability and Accountability Act (HIPAA), Stark and Federal Anti-Kickback Laws and new CHIP and MACRA regulations that will impact healthcare effective immediately, with material financial impact by 2019. The report also recognized the major national push for Physician Quality Reporting Measures (PQRS) and Value Based Modifiers (VBM), all of which are clearly impacting EHRs, their mandates, and the interconnected demands from Meaningful Use (MU-1 and MU-2). The latter items impacting a physician’s daily activity with additional, potentially adverse, financial implications. Many of these regulations are encompassed in the MACRA regulations, yet instead of providing direction and guidance, they seem to make the case reporting worse, not better.

These programs are now going to be in some form aggregated in the Merit-based Incentive Payments (MIPS) that only now are barely emerging and way behind schedule. To the casual reader, this may sound like a great deal to manage, and while it is, this is exactly what makes the ACP report so timely.

The ACP report acknowledges that many private certifying organizations, such as the National Committee for Quality Assurance (NCQA) are responsible for the accreditation of healthcare facilities, health plans, ACOs and even emerging Patient Centered Medical Home Programs. These carry additional reporting burdens beyond those required by state and other federal programs, as well as most private insurance companies, and have a complicating, if not occasionally mutually-exclusive affect.

We believe that one of the most enlightening characteristics (and now the subject of this blog series) is about Electronic Health Records (EHRs) and EHR vendors, and the lack of truly useful solutions by the healthcare industry offered at the point of care. The EMR/EHR regulations have resulted in the healthcare industry becoming awash in technology companies with little to no healthcare experience, attempting to force-fit technology they understand into an industry (healthcare) that they have no knowledge of nor care to learn. We have pointed out before that healthcare requires a unique approach and those technology solutions that may appeal to other industries will not work in healthcare; moreover, the attempts at adapting or morphing such existing “solutions,” such as legacy billing systems, into a full EHR with features useful to the physician at the point of care has failed.

The report further notes that most EHR vendors are so busy complying with every expanding and needlessly complex federal requirements, that at many times, they are missing the point that the EHR care should be about patient care. The following excerpt is taken directly from the report (page 7) (we underlined key parts):

“Purveyors of EHR systems are working to comply with regulations, such as MU and the E&M documentation guidelines, but at the expense of being unable to offer tools that are tailored to a practice’s workflow and the clinical needs of its patients. In addition, EHR vendors have not yet had adequate discussions with frontline clinicians to better understand their needs, often leading to workarounds that create additional steps and burden. Therefore, the lack of usability and meaningful interoperability of EHRs has become one of the greatest sources of dissatisfaction among clinicians. 

Another problem practices face is the ever-rising costs of health IT products and services. Every new health IT module needed to perform a specific function comes with added costs. Often, EHR vendors charge additional fees for every interface to another system or service, as well as ongoing fees for moving data. Currently, a practice may be required to submit data to dozens of agencies. In the future, a practice also may have to exchange data with thousands of health care apps that patients may want to use. Moving large quantities of patient data from one system to another may be costly.” 

As we have noted before, most EHRs were not designed by actual providers of care and practice demonstrators with real world experience. Most EHRs were designed to meet thousands of requirements in the collection of data, the transmission, and the receipt of that data. It is a little like teaching to tests in education. Each EHR is then robustly tested by third-party approved laboratories for compliance; this is a time-consuming and incredibly complex process that does not address the patient providers needs for ease of use, information sharing or integration with a patient care team. The compliance process yields little value-added except ensuring that all that pass (not everyone does by the way) meet the “U.S. Government Standard.” In part, this is the reason why with nearly 70% compliance there is no discernible value-added brought to the providers table by traditional EHRs.

We took a different approach in designing and building PWeR® (Personal Wellness electronic Record®our EHR platform. Yes, we complied with all the mandates, passed all the accreditation and compliance hurdles. However, we also looked at benefiting the industry by going beyond mandates to do two key things. One, we have provided the means to connect providers to each other, as well as connect that group of providers to the patient – the patient’s care team. Second, we combined the Patient’s Personal Health Record (PHR) with their Electronic Health Record (EHR), something the ACP report specially calls out. By putting all this in an encrypted, HIPAA compliant, secure cloud environment, the integration and interactions of the care team can be performed in real time regardless of their location. Our PWeR platform is interactive and “actionable,” another key request of the ACP report.

We will address more on the ACP report and the future of EHRs in the next blog.

– Noel J. Guillama, President