As we have reported in Parts 1, 2 and 3 of this series, we are looking at the future of Electronic Health Records (EHRs). A recent position paper created, approved and released by the Board of Regents of the American College of Physicians (ACP) titled, “Putting Patients First by Reducing Administrative Task in Health Care: a Position Paper of the American College of Physicians” sparked a topic of conversation for this series.
We believe that this ACP paper is a landmark document of the good, the bad, and the missed opportunity of most, if not all leading EHRs in the marketplace today. After five years and over $100 billion (USD) invested, do EHRs provide better care, facilitate administration or engage the patient? We believe the ACP plainly says – NO.
As we conclude this series, we will refer to our previous source, the ACP report and “policy recommendations” as they relate to EHRs.
The final pages of the ACP report end with the concern for physician “burn-out.” The report acknowledges that physician burnout is “linked primarily to workflow, work control, the emphasis on quality and physician communications” demands, and adds “administrative tasks, EHR and extremely intense regulations.” They also highlight the need for physicians to have “better work-life balance” to avoid burn-out.
Of EHRs specifically, the final part of the report has a great deal to say:
The Commonwealth Fund recommends integrating administrative record systems, electronic claim submissions, shared provider enrollment and credentialing systems, and common quality reporting to reduce the redundancy and complexity that increase time and staffing costs for practices and hospitals.
As we have noted before, most EHRs were not designed to reduce redundancy, or to bring to the physicians more “actionable information.” For the most part, they have taken paper records and transferred them to digital format, designed as the report clearly states for “billing and compliance purposes.”
We can also take notice of this section of the “position paper:”
All stakeholders must actively work to refocus the EHR system to ensure that its primary purpose is to support clinical care delivery. The use of EHR data collection capabilities for secondary or alternative purposes, such as for billing documentation, measure and public health reporting, regulatory compliance, and others, must be redesigned in a manner that does not distract or detract from patient care and that effectively and efficiently provides patients with access to their own information.
All stakeholders must work to ensure that reporting requirements are modified and standardized to take full advantage of the capabilities inherent in EHR technology. Reporting burdens would be reduced dramatically if all stakeholders agreed to use the same data and structure definitions. Decision rules could be programmed into EHR systems to eliminate the need for prior authorizations.
We could just stop here, but we won’t.
The two paragraphs above are not only a cry for help, but also questions an industry that possibly has squandered a great opportunity. Clearly we have an agenda, however we also have a passion to help provide solutions that can both help providers provide better care, and do so more efficiently. We know technology can be a great tool; EHRs can do so much more than they are doing today.
The ACP recommended that all EHRs be required to receive payments and remittances advice, as well as recommend that all EHRs be integrated with personal health records.
The final two parts, before the conclusion on page 16, are too important not to quote directly:
Although the original intent behind the design of EHRs was to facilitate patient management and care, the technology largely has been co-opted for other purposes. Payers see the EHR as the source of billing documentation. Health care enterprises see it as a tool for enforcing compliance with organizational directives. The legal system sees the EHR as a statement of legal facts. Public health entities see it as a way to use clinicians to collect their data at drastically reduced costs.
Measurement entities see the EHR as a way to automate the collection of measure data, reducing their reliance on chart abstraction. Governmental entities see it as a way to observe and enforce compliance with regulations. All these impositions on EHR systems have created distractions from their potential value in supporting care delivery. Vendors of EHR systems consider it their primary responsibility to meet the requirements of all of these entities. They argue that the time required to meet all these nonclinical requirements leaves them no time to enhance the value of EHR systems for clinical care. The ability of these systems to support care delivery will not improve unless physicians and others who deliver care insist that the functions needed by clinicians and their patients take priority over nonclinical requirements.
In the “conclusion,” the APC ends this position paper on this final paragraph.
Policymakers and other key stakeholders, therefore, should collaborate with frontline clinicians and their patients to restructure the existing technology to help streamline information and processes in our health care system. The recent ACP article “Clinical Documentation in the 21st Century” notes that EHRs must support the concept of “write once–reuse many times” and embed tags to identify the original source of information when used after its creation (6). An EHR system must allow clinicians to easily search available data during note writing and provide the option to link content from previous entities or copy and paste with appropriate tags. To the extent that the “reusability” of the collected data increases, the need to collect additional data for secondary purposes will decrease.
Why is this part so important?
Technology today can help solve some of the biggest problems physicians face, minimal sharing of information between providers, lack of a care team approach, and frankly little use of technology to interact with patients. Yes, taking notes within an EHR should provide more convenience and ability to “cut and paste with appropriate tags” however, why are they not doing it? One conversation with a physician and this will be on their short list of requests, the ACP puts it in writing for all to see.
In the final section the ACP goes on to write:
Along with other health IT, EHRs actually may become a solution to the problem of administrative burden. To make this possible, all major stakeholders must agree on and implement several changes, including using the same data elements and reporting formats; enhancing clinical decision support to replace the need for other non–real-time forms of guidance and oversight, such as prior authorization; and using shared registries to collect data from practice reports to then be queried by all agencies to meet their requirements. A major source of reporting burden is the tendency of each agency that collects data to use different data definitions and report formats.
Now for the final paragraph:
The ACP also calls for meaningful collaboration to improve the development, testing, and implementation of measures and to ensure that health IT is used innovatively to streamline processes and reduce burden. In addition, although some consistency was found in the literature analysis regarding the effects of administrative tasks, much more research is needed in that area, as well as on the subject of best practices, to mitigate or reduce the burden of administrative tasks. Once defined, best practices must be disseminated widely. Excessive administrative tasks have serious adverse consequences for physicians and their patients. Stakeholders must work together to address the administrative burdens that fail to put patients first.
Why we built PWeR® (Personal Wellness electronic Record).
With 25 years of administrative experience ranging from single physician practices, multi specialty medical centers, owning billing companies, third-party administrators, and helping administer hospitals providing care management to over 20,000 patients, our perspective was always what has been so well articulated by this landmark position paper by the ACP.
The main purpose of any EHR should be to enhance the quality of care and simplify the extreme administrative burden physicians face today. We believe that the third-generation of EHRs must provide more information than a single physician can generate.
That third-generation of EHRs must help assimilate the patient’s current wellness, by bringing other providers into the care team. Yes, the third-generation EHR must manage the patient’s interaction with payers and perform billing functions, however that should not be at the risk of complicating the doctor’s life more and missing the purpose of the EHR. Any third-generation EHR must also facilitate patient interactions with his care team.
Third-generation EHRs do not require dozens of mouse clicks to find information, they use the latest technology to facilitate a dashboard that allows for a quick assessment of the patient’s wellness. Today, we’re happy to say that PWeR is such a product; we focused our platform on providing ease-of-use, total patient wellness, and a platform that is driven to facilitate patient interactions.
We believe that we are at the dawn of the next era in EHRs! Over the last five years, we have witnessed the costs associated to building an EHR; we are entering an era where EHRs will be valued on how well they promote wellness. PWeR is ready to spark into this new age of EHRs, by providing the best collaborative tool for care teams, providing value-added functionality to the physician, connecting to a host of third-party providers of data, communications, transaction interaction with insurance companies, laboratories, and pharmacies securely available in the market today.
It is time to build a new future of EHRs and it can be done with PWeR!
– Noel J. Guillama, President