RETURN TO ARTICLES PAGE 

RETURN TO HOME PAGE 

Healthcare IT Interoperability

A Six-Part Series by Will Stabler

About This Series

I wrote this article series in six parts over two months during early 2017 when there was considerable news being made and on the horizon in healthcare IT interoperability.

Articles in This Series

Interoperability is the way we get to data that can empower patients to become more involved in their health care in a way that benefits them, plans, providers and the system as well by creating a healthier overall population.
 
As efforts to achieve interoperability move forward, many challenges and obstacles lie in the way, including reluctance to share information for many reasons, including competitive advantage for both providers and developers, costs and liability.
 
This article examines the two most important users of healthcare information—the clinician and the patient—and where they interface, in the electronic Health Record (EHR).
 
4. EHR Interoperability and Adoption: To Do This We Need Physicians
Everyone involved in EHR interoperability and adoption needs to take seriously physician concerns over loss of patient interaction & the squeeze on time that can potentially result in loss of revenues.
 
We need patients using their health information and giving their feedback to clinicians in shared decision making and care management relationships. From there we can improve the interaction that goes on there among those two human elements and the technology so we can create that world where patient-generated data comes to the forefront.
 
Interoperability should eventually take us to a place where patients and providers are enabled to work as a team toward preventive medicine and value-based care. This is a place where patients have access to their full medical records, and are working in decision making partnerships with their healthcare providers.

EHR Interoperability and Adoption: To Do This We Need Physicians

By Will Stabler

First published on April 20, 2017

In my previous article I wrote about some of the problems physicians and executives have with EHRs, including interoperability, and then promised to talk about EHR adoption in this installment. In the risk adjustment world in which I work, physician engagement is a big deal, because without it, we cannot collect the timely, high-quality data we need to meaningfully assess the health of our populations, and accurately adjust risk.

The Concerns of Physicians are Many

In the previous article in this series I cited a report released in March of a study conducted for NEJM Catalyst titled, “Care Redesign: What Data Can Really Do for Health Care,” which found that lack of interoperability was listed as the number 1 “biggest barrier” to better use of patient data (72% of respondents). These healthcare executives, clinical leaders and clinicians in the study further rated “difficulty collecting data” as the number 2 barrier (62%) and “time required” close behind at number 3 (60%).

While I was researching this article last week, the American Health Information Management Association (AHIMA) Foundation released its Spring 2017 issue of “Perspectives in Health Information Management,” which contained an interesting study about small physician practices and electronic health records.

It seems that physicians are not only concerned about the EHR’s effect on their efficiency and quality of care, but physicians in small practices (of four physicians or less) are most concerned about losing face-to-face time with patients, and some worry the EHR could sink their practices because of the time involved. Keep in mind that these small practices account for 46 percent of physicians in the nation.

In this qualitative three-round survey of 15 expert panelists, titled, “Potential Effects of the Electronic Health Record on the Small Physician Practice: A Delphi Study,” the respondents came to a consensus that EHRs would reduce the volume of patients that could be seen in a day, resulting in a decrease in revenues. Respondents to this study say that they spend more time entering data than they do assessing their patients and interacting one-on-one with them, and that even though patients experienced a longer total visit time than before the introduction of the EHR, they seemed to be less satisfied with their visits.

None of the responding panelists said that their practices experienced an increase in volume of patients due to the EHR. In fact, several of the panelists reported decreases in volume because of the increased documentation time, with some reporting significant decreases.

The panelists also reached consensus that reduced focus on the patient resulting from EHR use could cause them to miss medical conditions. This is not only harmful to the patient, but from a risk adjustment standpoint, misdiagnoses and missed diagnoses can be harmful to the bottom line, not only for the practices but for their associated health plans, and the entire healthcare system as well.

American health care of late has been deliberately moving toward a system that is based on value rather than volume for good reason, but I don’t think this is precisely what we’ve been talking about, and it’s certainly not the way we need to go about it.

The discussion of the AHIMA report contained this chilling statement: “One physician in a single-physician practice who did not participate in the survey emailed that he had recently closed his practice and moved to a hospital setting to avoid the complications of EHR implementation. He cited a lack of technology understanding and stated that he felt the costs to employ others would be too much for his small practice to sustain.”

So Where is the Good News?

The AHIMA study was not all doom and gloom. The panelists believed that costs for electronic medical record management could possibly decrease with “automated processes, streamlined record transfer and optimized patient portals.” They also felt that coding for reimbursement could be improved by EHRs.

The AHIMA study concluded that physicians may need to consider the use of medical scribes to increase efficiency in documentation, potentially giving them more time with patients while also increasing the volume of patients. The study cautioned that more research is needed into the effect in small practices on patient care and finances from the use of medical scribes.

In any case, everyone involved in EHR implementation and adoption—including government regulators and vendors—need to take seriously physician concerns over loss of patient interaction and the squeeze on time that can potentially result in loss of revenues. Physician engagement is critical because we can’t have a health system without them.

And when looking toward the future, we can’t forget another key element—patients and the effect their anticipated increased involvement in their care will have on healthcare informatics.

In the NEJM survey, respondents were also asked to identify the most useful sources of data today and in 5 years. In the present, clinical data rated highest by far at 92% while at number 2 and number 3 were cost data (56%) and claims data (45%). However, when asked about what they believed would be the most valuable sources 5 years from now, claims data will drop off significantly in value (scoring only 32%), and clinical and cost data will be joined at the top by patient-generated data and genomic data (both scoring 40%).

In the next article I will address how interoperability all comes together for the patient in a value-based system.