The Future of EHR's (Part 3)

The Future of EHR's (Part 3)

Part 1 of this series began with a reflection on the use, practicality, and future of Electronic Health Records (EHRs). For convenience in our discussion, we separated EHRs into two distinct categories: first, the EHRs primarily driven to produce documentation that supports the medical billing transaction, and the second category are those designed and driven to support high-end specialty practices, excluding hospital or acute care. Today, we find few EHRs solving the real-world problems faced by small and mid-size medical practices as most of the EHR companies have gone for the big score in high-end specialties and hospitals.

In Part 2, we elaborated a bit further and provided additional data based on a recent position paper created, approved and released by the Board of Regents of the American College of Physicians (ACP). This 23-page report titled, “Putting Patients First by Reducing Administrative Task in Health Care: a Position Paper of the American College of Physicians,” effectively challenges the “U.S. Government” to reduce healthcare regulations, or at least make them more relevant. Additionally, it challenges the EHR industry to solve real problems and provide tangible ROI as the country has invested billions (USD) in EHR technology over the last five years. In this blog, we will dive deeper saving the next few blogs of this series to reach a conclusion.

The ACP report goes to say,

“Although EHRs have many inherent problems and are affected by several environmental and regulatory drivers, as discussed earlier they still may offer benefits, such as the ability to track laboratory results effectively, view patient information both longitudinally and discretely, manage patient populations, and access patient records remotely—but only if the practice understands these benefits and is trained to take advantage of them.”

The challenge today is that most EHRs, even if used as designed, will continue to silo the small practice provider. We should also recognize that all “Meaningful Use” (MU) EHRs must connect to third parties, and even fourth and fifth parties. What is missing is actual care coordination.

That is why in an environment where there is 60-70% compliance, there are still a high percentage of paper records between doctors that care for the same patient, which negates interconnectedness of the Care Team. From actual case studies, we know that the average primary care provider with paper records today has 150,000 to 200,000 pages of records, and even practices that have an EHR, still use paper materially.

The saddest thing for us to see is when “data” is duplicated between computer systems, converted to paper, and then stored in a “duplicate” paper record in HIPAA-compliant (supposedly) file vaults. In the United States, we estimate that there are over 10 BILLION electronic healthcare transactions.

Recently, we had a conversation with a colleague and posed the question, are we bleeding the patient faster? We were referring to the nearly 2,500-year-old practice of bloodletting that was an acceptable practice well into the 18th century in the U.S.

Today, we have a great deal of healthcare data, and yet there is little tangible evidence that we have reduced costs or improved healthcare quality by using EHRs in a measurable way. Why?

We believe two substantial reasons for this failure are the lack of interconnectivity due to duplication of records, both paper and digital coupled with minimal patient interaction. In a world where we can remotely start our cars using our phone, use that same phone to start our lawn sprinklers, turn on our house lights, change the thermostat setting, as well as access our personal data anywhere; EHRs are effectively “bleeding the patient faster,” using systems, processes and practice models that have been in use for half a century or longer.

The APC report acknowledges the material move forward towards incentive-based payments, outcome-based measurements, as well as the desire for patients and families to be actively involved in a patient’s care. Today, EHRs are chronically underperforming in that environment.

Question our conclusion? 

The APC notes that, “for every hour a physician spends with the patient, he or she spends an additional two hours on EHRs and other desk work” (page 10 of report). The APC report goes on to document the fact that doctors are spending up to “6.5 hours per week – more time than was spent on paper records.”

Complexity of EHRs 

A recent study examining the hospital-based EHR noted that a “physician transacted 10,000 mouse clicks in a 10-hour emergency room shift.” Though EHRs generally allow for a more complex and readable medical note and a very positive outcome, physicians are also exposed to more volume and complexity of notes that could be causing more distractions, “making it difficult for physicians to find the most useful and actionable information.”

The same thing that can and should help outcomes, is instead causing complexity. In a 2013 survey, it was determined that reporting and documenting could compromise care. We will note that in a report in the Journal of the American Medical Association (JAMA), it was documented that physicians were spending 49.2% of their time in EHR documentation versus 33.1% in direct clinical face-to-face time with patients.

Without knowing our perspective as you read this blog, you might conclude that we are not supportive of EHRs or that we are aggressively against the investment of more than a hundred billion dollars that has already been plowed into the digitization of America’s health care system over the past five years. However, that conclusion could not be further from the truth.

We have spent a quarter century frustrated with a healthcare industry where healthcare cost has gone up 300% and is now approaching 20% of U.S. GDP. We have witnessed firsthand the tremendous benefits technology can bring to the overworked physician, who through the ACP report is requesting help. We have seen how using technology and new processes, patient care can improve and decrease the total cost of care.

On the contrary, we not only support more technology and EHRs, we support better and more functional EHRs. That is why we helped design, build, test and are currently deploying a new type of EHR; one that is designed to complement the workflow of a practice – PWeR®Personal Wellness electronic Record™ and as the name indicates our goal for the patient.

Today, this platform does what EHRs should have been doing all along, live interconnectivity to the Care Team and to patients. A comprehensive landing page that provides the equivalent of heads-up display showing patients’ their “wellness status.” As with other EHRs, it connects to 90% of the pharmacies in the U.S., along with laboratories, diagnostic tools and has a comprehensive Care Management toolset. PWeR also connects to and interacts with payers, facilitating and expediting practice management functions.

What PWeR does better than anyone else is to live up to its “One Patient…Total Connectivity”™ capability that allow doctors to share (with patient consent) real-time patient data, always connected medical information that is both up to date and is actionable. Unlike any EHR we know today, PWeR links the patient’s Care Team. As each additional provider connects via PWeR, the shared knowledge of the patient with the Care Team rises exponentially, and each one has more information on the patient than previously thought possible. Further, our cloud-based platform brings the Care Team, or individual physician, just two clicks from any relevant information on his or her patient.

In the final blog of this series, we will complete our review of the amazing work done by the ACP.

– Noel J. Guillama, President