The Executive Suite: What to do when your EHR derails productivity and value-based care

Wednesday, October 2, 2019

What to do when your EHR derails productivity and value-based care

Like it or not, value-based care (VBC) is expected to account for 59 percent of healthcare payments by 2020, according to the Aetna 2018 Health Care Trends Report.

This means physicians will have to continue to do more with less: Every patient experience will need to support the Triple Aim goals of quality care under the Centers for Medicare & Medicaid Services (CMS), including improved patient outcomes and lowered costs. Physician practices that can’t demonstrate high-quality, cost-efficient care may face steep financial penalties.

This is a daunting, onerous task for physicians, especially because existing communications technology may not adequately support Triple Aim goals. Electronic health records (EHRs) were supposed to support VBC by providing technology that enables primary care physicians to coordinate care across the continuum but many, if not most, EHRs don’t live up to the hype.

A recent JAMIA study revealed EHR use is still slowing physicians down, making them less productive and impacting the patient experience. As the American Academy of Family Physicians (AAFP) noted in a letter to the Office of the National Coordinator for Health Information Technology (ONC) in January, “Gaps in EHR functionality to support primary care practices are widening with the additional requirements of value-based payment models.”

Therefore, as we move deeper into VBC, we must consider the extent to which our existing medical documentation and data-exchange technology — especially our EHRs — are helping physician practices improve productivity and support collaborative relationships among care teams. EHRs should be part of the solution, not the problem.
EHR woes in a VBC world

As the AAFP suggests, physicians need EHRs to do more. It isn’t enough that we’ve achieved technical interoperability. We need seamless care transitions. We need care coordination, executed with the finesse of an Olympic runner handing off a baton in the 400-meter relay.

Consider CMS’ 2018 Psychiatric Collaborative Care Model (CoCM), which offers reimbursement to primary care providers who coordinate care effectively with behavioral health providers. The model requires a high level of teamwork from providers in different settings. On the surface, this seems easy enough.

But if an EHR isn’t easy to navigate and information isn’t easy to share, care partners won’t have access to the data they need to support the patient. So, for example, if a patient misses a dose of medication or a psychiatrist doesn’t report that a drug-addicted patient relapsed, the primary care physician could unknowingly prescribe the wrong medication, and the patient could end up in the emergency department.

If care partners can’t or won’t “talk” to each other through their communications technology system — pushing time-sensitive information in real time, documenting changes in medication, reporting new interventions or patient progress — they are undermining care. And even one weak care partner link in an accountable care organization (ACO) can derail patient progress and financial incentives.

5 EHR Best Practices

Given these challenges, we need to assert a better team-based approach that’s supported by an arsenal of smarter, more effective technology. Does your existing EHR suffice? Here are five best practices to consider when evaluating your existing EHR through the lens of VBC.

1. Ask questions

One of the best ways to begin the technology evaluation process is to simply ask physicians in the practice about their experiences. Are there a lot of EHR-specific complaints? Does the organization’s existing technology solution help the practice streamline workflow, or are providers left wanting more? Answers to these questions can help a practice determine whether it needs to update or revamp its technology solutions.

2. Work with clinical partners

Sometimes it isn’t the EHR that’s slowing down physician workflow at your practice. Case in point: When care partners in a collaborative network aren’t all using interoperable EHRs, coordinating care becomes more time-consuming: Physicians have to make calls to request information, wade through documents or seek answers by querying outside sources.

As your practice enters into collaborative partnerships, ask about the technology your clinical partners are using so you can plan communications accordingly. If your practice knows, say, that a behavioral health provider group still uses fax machines to communicate, it can discuss alternative strategies for streamlining information.

3. Leverage a VBC point person

Keeping up with healthcare regulations, especially in the migration toward value-based care, is overwhelming. A physician champion or administrative leader who understands regulatory trends and/or can track productivity and performance for initiatives such as Merit-based Incentive Payment System (MIPS) can ease stress. Small or solo practices may want to explore outsourcing these roles to a third party.

4. Seek support

A technology solution is only as good as its vendor support team. Practices need a vendor that understands their unique needs as they navigate quality initiatives, MIPS reporting requirements and patient care trends. A vendor should not only understand how regulations impact collaborative workflows but also offer guidance on how providers can reach their clinical and financial goals.

5. Do your due diligence

When researching a new EHR system, compare features and functionalities. Ask the vendor for customer references and follow up with them: What has their experience been with the EHR? Was it better or worse than previous technology systems?

Take ownership of the process by involving all stakeholders in reviewing the EHR. And finally, ask that your vendor comes to your office for a “discovery” visit to demonstrate the EHR to your practice. Even if this requires a fee, it is better to experience a new technology system and make sure it supports VBC before investing in it.

Technology that improves efficiencies and streamlines productivity is critical for the next phase of VBC. As practices work more closely with other care partners, they need to ensure that their EHRs and other communication technology solutions are supporting — not detracting from — the care they provide to patients. Only then can they experience meaningful outcomes and advance the industry.