March 08, 2016
Looking Ahead: What’s the Future of EHR Initiatives?
The dawn of electronic health records (EHR) brought us a push to simply get the software into hospitals and physician offices. Then there was meaningful use — which is still ongoing, but will soon be part of the woodwork. So what’s next in EHR initiatives? Here are three key drivers coming down the pike.
More-meaningful meaningful use
Last year, the president and Congress took two steps to put patients at the forefront of how the Centers for Medicare and Medicaid Services (CMS) pays for care and supports physicians. First, the Obama administration set a goal that 30% in 2016 and 50% in 2018 of Medicare payments will be linked to getting better results for patients, providing better care, spending healthcare dollars more wisely, and keeping people healthy. On the back of that, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which considers quality, cost, and clinical practice improvement activities in calculating how Medicare physician payments are determined.
While MACRA also continues to require that physicians be measured on their meaningful use of certified EHR technology for purposes of determining their Medicare payments, it is further focused on more-meaningful meaningful use. According to the CMS blog, the rollout of MACRA will be defined by:
- Rewarding providers for the patient outcomes technology helps them achieve
- Allowing providers the flexibility to customize health IT to their individual practice needs —technology must be user-centered and support physicians.
- Leveling the technology playing field to promote innovation, both by and resulting in improving interoperability
- Prioritizing interoperability by implementing federally recognized, national interoperability standards and focusing on real-world uses of technology.
“The challenge with any change is moving from principles to reality,” says the blog. “The process will be ongoing, not an instant fix, and we must all commit to learning and improving and collaborating on the best solutions. Ultimately, we believe this is a process that will be most successful when physicians and innovators can work together directly to create the best tools to care for patients.”
Transparency in patient records
Although patients are legally allowed to access their records — in fact, it’s a right that they be allowed to see any data about themselves — it’s often a difficult process for both sides, not to mention time- and resource-consuming for hospitals, physician offices and others.
The OpenNotes project just received $10 million in new grants, to aid its work with medical providers to expand patient access to their own health records and the notes clinicians have made about them. Initially started as a research project, the boost means that OpenNotes could increase transparency and records access from the current 5 million, to as many as 50 million patients.
It’s quite a simple, straightforward idea, really: After a physical exam or other healthcare contact, patients are able to use an online portal for easy access to their doctor’s visit notes, which may include a summary of their conversation, the symptoms they described and their doctor’s findings from a physical exam. A survey in the Annals of Internal Medicine reports that, after one year of the pilot, more than two-thirds of physicians at participating hospitals thought the program was a good idea, and 90% of patients thought open access to notes was a good idea.
Benefits include improved communication between patients and their providers, as well better medication adherence on the parts of patients. This is particularly important, as coordinated, patient-centered chronic care management becomes ever more entrenched in healthcare. However, achieving open access starts with thorough documentation of the patient encounter, preferably taken in real time by someone other than the physician (such as a medical scribe), so that the doc is free to maximize both the visit and the record.
Lighter physician burden
Speaking of maximizing the physician’s time and skills in ways that benefit the patient, the government is starting to take notice. The Senate Health, Education, Labor and Pensions (HELP) Committee has unanimously passed legislation that will help lighten the physician burden when it comes to EHR.
The Improving Health Information Technology Act establishes a non-biased EHR rating system with regard to physician usability, system interoperability and general security. In addition, the act will help alleviate physician burden by allowing non-physicians and members of a care team (such as medical scribes) to document on the physician’s behalf. The idea is to help users achieve what EHR was always meant to do: streamline care delivery, let physicians do the work they trained for, and enhance patient documentation.
“Our goal is to make our country’s electronic health record system something that helps patients rather than something that doctors and hospitals dread so much that patients are not helped,” Senator Lamar Alexander, the committee chair. “We have worked for months — with input from those who actually use the system — to help improve health information technology and I’m glad to see this legislation move forward as part of a successful first meeting on our committee’s bipartisan biomedical innovation agenda.”
As you can see, there’s a pattern forming: While patients are still part of the focus, governmental and NGO efforts are starting to see that, without a focus on physicians, the value of EHR will never be maximized. And what’s good news for physicians is good news for better delivery of healthcare that improves outcomes.