Extending the value of the EHR

Aug. 29, 2017
L. Patrick James, M.D. Chief Clinical Officer for Health Plans and Policy, Medical Affairs, Quest Diagnostics

It goes without saying that physicians need more data and analytics to succeed under new value-based care models. For physicians seeing hundreds of patients, navigating requirements that vary by benefit type, health plan, and patient, treatment is nearly impossible. Technology has the potential to alleviate this complexity, empowering physicians to identify and close gaps in quality, risk, and utilization—essentially in real time and within their current workflow processes.

But technology only is helpful to physicians if they can access and utilize it, and according to a new study from Quest Diagnostics and Inovalon, “Progress on the Path to Value-Based Care,” only 43% of physicians say they have the tools they need to succeed. As a result, many physician practices have turned to their existing health information technology (HIT) to support their value-based care initiatives. Others, lacking appropriate technology, have developed workarounds. Neither of these options are ideal, but they aren’t the only choices available as emerging tools promise to extend the value of practices’ existing technology solutions.

Turning to existing HIT

For the most part, physicians are using the tools they have available—primarily electronic health records (EHRs)—to support new value-based care initiatives. Often, EHR implementations cost millions, or even billions, of dollars and it can take years to set up a new EHR infrastructure. Those are two good reasons why a practice would want to derive as much use as possible from its EHR.

Many physicians are frustrated with the limitations of this technology, however, and only 54% believe EHRs have everything they need. Even more troubling, 70% of physicians said they don’t see a clear link between their EHRs and better patient outcomes. So how can they rely on this tool to support their transition to a reimbursement system that will reward them for the value of the care they provide?

Physicians need feedback on their performance so they can identify gaps in care and adjust their workflow to improve patient experiences and outcomes.

In addition to potential constraints due to expense and implementation delays, EHRs may suffer gaps in content and not include episodes of care delivered outside of the EHR-supported environment. EHRs were not designed to extract and document data to support value-based reporting requirements. Take quality reporting, for example. Once a practice’s physicians select the quality measures they want to track, it’s discouraging for them to realize their EHR can’t track those measures in a meaningful way. In effect, practices are forced to select quality measures that their EHRs can support.

Developing workarounds

Recognizing the limitations of their existing technologies, some medical practices are creating systems in-house to meet their data and documentation needs. But this workaround comes with its own challenges.

The biggest challenge to overcome is that it takes multiple years and considerable financial investment to develop the back-end infrastructure to support new value-based care models. Building a proprietary HIT system is a huge undertaking for a large health system, let alone a private medical group, and small solo practices don’t have the financial resources for this type of undertaking.

Another challenge is getting physicians to use new reporting platforms. For the most part, data analysts with the knowledge to build the HIT infrastructure don’t have the clinical background to understand how it needs to function. And, once the system is set up, if it’s not accurate and doesn’t fit in physicians’ workflow, they won’t use it. This problem can be overcome by getting physician leaders involved in the design process, but it’s unrealistic to expect physicians to dedicate what could take hundreds of hours of technology development, especially given practitioners’ existing complaints about how reporting is taking time away from patient care.

Adopting emerging tools

Considering the barriers to starting from scratch, the EHR—with all of its limitations—is the tool with the most potential to support value-based care. Here’s the catch: the EHR becomes far more useful when coupled with emerging point-of-care analytics.

Most physicians (71%) said they would be willing to spend more time using technology if their EHRs could yield insights unique to their patients. That’s where new analytics technologies can play a role. Advanced analytics available through the EHR can help physicians easily identify and address gaps in quality, risk, utilization, and medical history to improve care delivery and avoid losing reimbursement.

Beth Israel Deaconess Medical Center CIO John Halamka, M.D., MS, recently wrote in his blog, “Although the major EHR vendors are working on usability improvements, I believe the greatest agility will come from the startup community via apps that get/put data with EHRs using APIs [application program interfaces] based on evolving FHIR [Fast Healthcare Interoperability Resources] standards.” But most analytics companies come at the healthcare landscape through the data heap. Analytics developed outside of the healthcare industry may be agile, but not necessarily useful for physicians.

Moving the needle toward value-based care

To make a real difference in accelerating the adoption of value-based care requires relationships with physicians, providers, patients, and payers. Only when analytics platforms focus on the true north—cost, quality, and patient satisfaction—can they provide actionable insights at the point of care that can improve patient outcomes and financial performance under value-based care models.