Is your Replacement EHR Smart Enough for Value Based Care?

The following is a guest article by Charles Hutchinson, CPA, is the Chief Financial Officer of InSync Healthcare Solutions.

In the evolving landscape of value-based care (VBC), providers are finding that they need more from their EHRs than ever before. The unexpected surges in need for care, like that of COVID-19, make it more critical than ever to have access to robust functionality—functionality that can navigate clinical care plans, transmit data to pharmacies and care partners, and ensure patients are meeting their healthcare goals and trending in the right direction.

In the nearly 11 years since CMS’ meaningful use program took hold, most, if not all, physicians have replaced their original, or legacy, EHR. Now, many believe that 2020 may kick-start a new round of upgrades. In 2019 alone, more than one in four physicians and ambulatory providers surveyed said they planned to replace their EHR.  With good reason: We’re seeing increasing demand for EHRs to support ancillary applications like telehealth and more effectively coordinate care with payer partners.

Equally crucial to the discussion of replacement EHRs is the necessity of technology to position providers for the future of VBC effectively. Time is of the essence as these models are now increasing at breakneck speed: Between January and March 2020, multiple insurers, including Blue Cross Blue Shield, Humana, and state Medicaid agencies, rolled out VBC initiatives.

But for providers in the EHR replacement market, finding the right new technology solution isn’t always so simple — and the stakes couldn’t be higher.

Before embracing a technology solution that is packaged beautifully and works well during an onsite demonstration, a practice needs to consider the purpose of an EHR investment thoughtfully. Physician practices need technology that’s intuitive and supports clinical workflows. They also need technology that supports VBC and is flexible enough to accommodate ever-changing regulations.

Why Your Replacement EHR Matters to VBC Goals

Multiple factors are influencing the need for a smarter EHR.

First, there are clinical factors. For example, legacy EHRs supported CMS’ EHR Incentive Program but were often pre-loaded with so many applications and alerts that documentation became cumbersome. A 2013 study showed that one-quarter of drug alerts received by a primary care provider, and one-third of clinical reminders, were repeats for the same patient within the same year. While many EHRs in the first phase of the replacement market — around 2013-2015 — solved this problem, the damage was done: Clinicians became less likely to accept alerts as they received more of them, and in some cases, were more likely to miss critical notifications.

There were other clinical problems, too, with legacy EHRs, namely that their workflows were cumbersome and frequently triggered physician burnout. More than 40 percent of boomer-age physicians say they are suffering from career burnout triggered by EHRs, according to Medscape’s National Physician Burnout, Depression & Suicide Report 2020: The Generational Divide.

Another recent survey suggests the number of physicians experiencing burnout due to EHRs is much higher.  A group of University of New Mexico researchers said that the clinical process design and clinical structure, which are both impacted by EHRs, is responsible for 40 percent of clinician stress. The hope among physicians who say they are stressed is that a smarter EHR can simplify documentation and eliminate non-essential notifications.  

There are regulatory factors, too, also influencing the need for a smarter replacement EHR. For example, the 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program emphasize care collaboration between healthcare partners and payer partners. Certified EHRs are required to play well together to support care collaboration and, in turn, uphold the core tenets of VBC: quality, efficiency, and outcomes.

Refreshing Your Replacement EHR Checklist

The decision you make about a replacement EHR should be based not only on what you like but what you’ll need for VBC in the coming decade. Some questions on a practice’s checklist should include:

  • Do you love the capabilities? The right replacement EHR should be flexible, with customizable templates that make every function — from documenting care in practice notes to ordering medications or viewing historical health information — easier. The EHR should be, at a minimum, fully loaded with features essential to support collaborative care. It should be easy for primary-care providers to coordinate with multiple care providers within an ACO or other shared-risk group and share insights to ensure everyone is on the same page.
  • Is this something your staff can and will use? Most clinical staff have some complaints about using EHRs instead of paper, but over the years, as electronic documentation has become the norm, these complaints have lessened. Still, lessons learned over the past decade underscore the importance of staff buy-in to support the implementation success and adoption of any new technology. Practice leaders should ensure clinical staff is present during meetings or demonstrations and have a chance to play with or test out any new technology before implementation.
  • Will it make providers faster? Most patient encounters, and especially those involving common diagnoses such as influenza, are pretty simple and manifest through simple interfaces. Smarter EHRs can, for example, leverage advanced algorithms to enhance compliance and automate charge capture for more straightforward billing through the use of pre-configured, customizable templates based on the most common patient conditions. If a patient with a standard medical condition checks into a practice, a smarter EHR can pre-populate fields with necessary information culled from the typical patient encounter (e.g., symptoms, medication orders, etc.). This way, physicians can focus more closely on the actual patient without having to worry about taking extensive notes during an encounter.
  • Are you getting the support you need? As discussed, a smart EHR that is compatible with an organization’s practice management (PM) system can auto-populate data fields, aggregate information, and ensure care is seamlessly scheduled, rendered, and paid. Yet technical difficulties can still happen. With the right vendor, a practice isn’t left in the dark trying to resolve them. It can count on easy access and availability to resolve any glitches or bottlenecks that might arise and slow down the workflow.

A practice’s EHR is central to improving efficiencies and patient care — and positioning for the future of care delivery. As VBC normalizes and overtakes fee-for-service (FFS) models, EHRs must enable physicians to do necessary tasks quickly and easily, so patient care can remain central.

Over the next several years, practices will have to navigate a sea of collaborative care arrangements and guidelines put forth by health plans, in addition to staying in compliance with new regulations. Make sure the next EHR can handle what’s coming.