Clinicians have become more vocal about frustrations using electronic health records (EHRs). Some articles have generated solutions, while others invite further discussion. In his article published in the New England Journal of Medicine, Allan Goroll suggests that changing payment schemes to “pay for outcomes” rather than “pay for processes” will result in fewer billing-related documentation requirements and better information for driving good decisions. His “pay for outcomes” is substantially different from the proposed “pay for value” plan that he says “relies even more heavily on EHR documentation and rewarding achievement on process measures” and doesn’t “correct the misplaced emphases on care processes and service volume.” John Levinson and colleagues, on the other hand, announce their intention to hold town hall meetings to discuss the problems they identified and announced on WBUR, Boston public radio and published in CommonHealth. They ask that administrators and clinicians work together to get better systems and ask government to re-think their requirements to fix the current systems that are “the medical equivalent of texting while driving, sucking the soul out of the practice of medicine while failing to improve care.”
In their paper published in JAMIA, Julia Adler-Milstein and colleagues address these issues by developing a roadmap for the future of health information technology (HIT) that takes into consideration the patient, provider and researcher/innovator perspectives. Their goal is to encourage the development of systems that will “support the transition to value-based care” as they note that current systems “lack the capabilities needed to succeed” in this endeavor. By addressing the needs of the stakeholders, they show the way that all can be satisfied with a unified approach.
One would assume that the patient and provider perspectives would have a lot in common, but there are differences. Patients need better and more timely access to their own health information, and the ability to contribute information to their medical record so it is complete and accurate. There is much work to do in this area, as patients have not typically been able to contribute data. Better ways to make their data meaningful to them, their caregivers and clinicians are still being designed. In addition, patients increasingly seek ways to participate in research, and sharing their medical information is an important part of facilitating that process.
Providers, on the other hand, have many business needs not always obvious to patients. They need to create documentation that supports payment for services in addition to other administrative purposes, such as quality reporting. To give good care, they often need to access historical patient information from other healthcare settings, and information that supports clinical decision making – which has not been easy to access. All this entails a lot of raw data that can be quickly and easily accessed for decisions and documentation.
The authors propose a set of simplifications that could make lives easier for clinicians. Specifically, they recommend simplifying documentation necessary for direct care, quality reporting and billing. They point out that value-based care reimbursement shouldn’t require details about each clinical encounter that justifies reimbursement, but rather should support communication among clinical team members and the patient as its highest priority. Demonstration projects supported by CMS and HHS could test various methods of reaching these goals.
As the demand for more research and innovation from payers and consumers increases, ways to integrate these efforts with clinical care makes more sense. To accomplish this, changes will need to occur that allow/facilitate more granular data sharing and informed consent. Devices and apps that generate data for clinical decisions will need to be vetted for privacy and safety. Also, algorithms could be based on a “trusted sources of the knowledge base” maintained by specialty organizations or medical colleges, thereby providing a basis for trust and speeding progress at the same time.
As consumers become more comfortable with technology and digital health information becomes more ubiquitous, using HIT to meet patient and provider needs will become easier and more integrated into everyday life. Data will flow into HIT systems in real time instead of having patients summarize their issues and symptoms four times per year in their physicians’ offices. Systems will be more flexible in supporting data requirements so that different types and sources of data can be accommodated in the same place. In addition, different data displays for different stakeholders and populations will also be created so that new needs can be easily satisfied. Datuit is working to support these capabilities as the needs become apparent. The SafeIX Platform supports applications that patients, providers and researchers/innovators can use to work together to develop better user experiences for various patient populations and for various clinicians. In addition, business executives who need data to manage their resources and revenue cycle will be able to make timely data-informed decisions because that data will be available when they need it. Moving from one-size-fits-all systems to more flexible needs-based user interfaces will be an evolutionary process but one that will be well worth the effort.
1. Goroll AH. Emerging from EHR Purgatory – Moving from Process to Outcomes. N Engl J Med 376(21):2004 (2017). Accessed at http://www.nejm.org/doi/full/10.1056/NEJMp1700601#t=article.
2. Levinson J, Price BH, Saini V. Commentary: Death By A Thousand Clicks: Leading Boston Doctors Decry Electronic Medical Records. WBUR/CommonHealth (May 12, 2017). Accessed at http://www.wbur.org/commonhealth/2017/05/12/boston-electronic-medical-records.
3. Adler-Milstein J, et al. Crossing the health IT chasm: considerations and policy recommendations to overcome current challenges and enable value-based care. JAMIA 0(0):1 (April 5, 2017). Accessed at https://academic.oup.com/jamia/article/doi/10.1093/jamia/ocx017/3072328/Crossing-the-health-IT-chasm-considerations-and .