May 26, 2015
Electronic Record Sharing: Is It Enough?

Interoperability is the next big buzzword in electronic health records (EHR). That’s because, in a big step forward, the Department of Health and Human Services (HHS), via the Office of the National Coordinator for Health Information Technology (ONC), has released a proposal for the safe and secure exchange and use of electronic health information.

“Great progress has been made to digitize the care experience, and now it’s time to free up this data so patients and providers can securely access their health information when and where they need it,” said HHS Secretary Sylvia M. Burwell in a release about Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Version 1.0. “A successful … system relies on an interoperable health IT system where information can be collected, shared, and used to improve health, facilitate research, and inform clinical outcomes.”

The draft Roadmap calls for:

– Core EHR technical standards and functions
– Certification to support adoption and optimization of health IT products and services
– Privacy and security protections for health information
– Supportive business, clinical, cultural, and regulatory environments
– Rules of engagement and governance

In addition to increasing the ease of information exchange between different EHR systems, the proposal is expected to lead to transparency in medical data, prices and provider performance, all of which are part and parcel of the HHS movement toward reimbursement for quality and effectiveness of care.

The Roadmap is an ambitious and much-needed initiative on the part of HHS, particularly when you consider that the sharing of EHR sometimes literally amounts to printing the record in one location, and having it typed into the EHR system at another. Which goes some way toward explaining why physicians are notoriously long-frustrated by EHR: 83% report they resist using EHR due to poor EHR interoperability, limited EHR messaging capabilities, and poor usability that makes it difficult to find relevant clinical data, according to a recent survey.

Furthermore, the majority of physicians in the survey also report that they lack the tools and processes to support collaborative, team‐based care. And that’s the real end game of EHR interoperability: care coordination.

The Agency for Healthcare Research and Quality (AHRQ) recommends that care coordination activities include:

– Establishing accountability and agreeing on responsibility
– Communicating/sharing knowledge
– Helping with transitions of care
– Assessing patient needs and goals
– Creating a proactive care plan
– Monitoring and follow-up, including responding to changes in patients’ needs
– Supporting patients’ self-management goals
– Linking to community resources
– Working to align resources with patient and population needs

Using scribes — who document the patient visit in real time — is critical to these goals, which are ultimately the goals of HHS. Scribes help physicians focus on the patient during each contact, minimize the distractions (and time-wasting) of entering data to EHR systems, and ensure that documentation will communicate knowledge to patients and other providers, help with transitions of care, and lay the foundation for monitoring and follow-up — all the sorts of efforts endorsed by the AHRQ. When you consider that the average hospital loses $1.7 million per year due to inefficient care coordination, the case for scribes in meeting care coordination goals is clear.

Care coordination efforts don’t have to wait. In fact, the success of HHS’s EHR interoperability program rests on maximizing care coordination — and ensuring that documentation is thorough and data collection efforts are appropriately focused in the first place.