The Future of Electronic Health Records: Can EHRs Adapt and Improve?
The American Medical Informatics Association (AMIA) recently issued a statement on the future of electronic health records (EHRs). They believe that EHRs need to be reimagined and redesigned in order to meet the challenges of the coming years.
Current EHR systems are designed around documentation for the evaluation and management (E&M) coding system. This charting style is currently necessary since the payers demand expanded documentation to justify increasing the E&M levels of physician compensation.
An E&M Level 2 patient visit requires far less complexity and documentation than a Level 5 visit, which has virtually all aspects of the patient’s history and physical carefully documented in the EHR. The AMIA states that these systems must break free of their current role as the generator of billing codes, and urges the industry to move away from using EHRs to collect information that is mainly of concern to the payers.
In the opinion of the AMIA, continuing with E&M-type charting in electronic health records will only slow progress towards a more efficient charting system.
Interestingly, changing the E&M charting model has some support from the federal government! A recent announcement from the Department of Health and Human Services stated that an increasing portion of Medicare payments will go to alternative payment models in the future, such as affordable care organizations (ACOs) and patient-centered medical homes (PCMHs).
By emphasizing shared risk and capitation models, the government will lead the way toward disconnecting documentation from E&M codes.
The AMIA also believes that new methods must be devised to make it easier for physicians to record their notes in EHRs. And EHR developers must begin to take into account new sources of information, including data generated by mobile apps and genomic data.
Usability has always been a major complaint from physicians regarding their EHRs. A recent study showed that first-year residents at Beth Israel Hospital spend on average 5 hours a day charting in electronic medical records. Noting that some physicians spend half their days charting in their EHR, the AMIA suggests that care providers other than the physicians, and especially the patient, should have a more direct involvement in populating a patient’s medical record.
The EHRs of tomorrow will also need the ability to integrate data from a variety of sources. This calls for the use of public application programming interfaces (APIs) in order to extract data from EHRs and to enable EHRs to interact with external applications. Although application programming interfaces (APIs) are necessary to increase the flexibility and innovation of electronic health records, APIs require open source code for EHRs, and few companies have envisioned this type of software and service model.
The AMIA statement made no mention of the importance of configurable workflow. Workflow enables the right information to be presented at the right time, more specifically, at the point-of-care. Very few companies have built the EHR user interface on top of a workflow engine, allowing for configurability to adjust to each physician’s practicing style. Almost all EHRs in use today are not even close to a true workflow system. See www.chuckwebster.com for more information on electronic health records and the importance of workflow models.
The real game changer for future EHRs will be the ability to place real-time outcome studies and therapy efficacy information at the point-of-care. This will, unequivocally, require a workflow engine.
The data analytics will include not only information about how various therapies are working for certain patient types or in certain areas, but also the efficacy of the therapy in the individual physician’s practice. By reviewing their own therapy outcome data, many physicians’ prescribing and treatment behavior will improve. Additionally, the cost of a therapy will be displayed alongside its outcome information creating an outcome:cost ratio.
Imagine a scenario within the patient encounter where, after a diagnosis is made, a treatment screen appears displaying various medications and therapies, with their real-world efficacy for that particular diagnosis, and the cost of such medication or therapy. Presented with these two sets of data at the point-of-care, a physician can’t help but practice the type of cost-effective, evidenced-based medicine everyone is talking about!
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