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Electronic Health Records - How Many Support Co-ordination of Care?

  
  
  
  
  
  
  

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I cam across an interesting article on a very important topic that is very relevant in the light of recent discussion and legislation on 'meaningful use' of Electronic Medical Records (aka Electronic Health Records).

It was a survey that involved sixty respondents, including 52 physicians or staff from 26 practices with commercial ambulatory care EMRs in place for at least 2 years, chief medical officers at four EMR vendors, and four national thought leaders. There were 6 major findings:

  1. EMRs facilitate within-office care coordination, chiefly by providing access to data during patient encounters and through electronic messaging;
  2. EMRs are less able to support coordination between clinicians and settings, in part due to their design and a lack of standardization of key data elements required for information exchange;
  3. Managing information overflow from EMRs is a challenge for clinicians;
  4. Clinicians believe current EMRs cannot adequately capture the medical decision-making process and future care plans to support coordination;
  5. Realizing EMRs' potential for facilitating coordination requires evolution of practice operational processes;
  6. Current fee-for-service reimbursement encourages EMR use for documentation of billable events (office visits, procedures) and not of care coordination (which is not a billable activity).

The third goal of 'meaningful use' focuses on improving care coordination by enabling exchange of meaningful clinical information among professional health care team by requiring the EHR to possess the following capabilities and functions:

  1. Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.
  2. Perform medication reconciliation at relevant encounters and each transition of care.
  3. Provide summary care record for each transition of care or referral.

Given the survey findings listed in the earlier part of this blog, I am personally skeptical how many of the current versions of EHR Software solutions can pass the three capability tests (as above). The jury is out and we will better know which EMR / EHR Solutions will effectively meet the goal as far as co-ordination of care is concerned in the next few months.

If any EMR / EHR vendors or current users of EMR / EHR solutions would like to share their understanding, knowledge or perspective on this topic, please feel free to leave a comment.

We will continue exploring different aspects of 'meaningful use' over the next several weeks.

 

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RevenueXL Inc. provides best value comprehensive solutions to medical practices. Our solutions include affordable Electronic Medical Records Software (a.k.a. EMR or EHR Software), Patient Portal, and Practice Management or Medical Billing software and revenue cycle services including medical billing, medical coding, coding audits and account receivables management services. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

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COMMENTS

I am a consultant for a 10 year old medical records company, Records 1-2-3, Inc. which has recently introduced an electronic version (AvivaEMR) of it's template based system. 
 
In answer to your invitation to comment: 
 
All three of your criteria for evaluating an EMR depend on a standard definition of what it means to meet the requirements. Our EMR can (or could with moderate modifications) exchange data, perform a medical reconciliation and provide a summary of care electronically if both we and the receiving entity agreed on what information in what data format would satisfy the requirement. But there's little point in creating a capability to output data if no one will agree to accept it. Software development is expensive enough as it is. With hundreds of other commercial vendors, scores of insurers, hundreds of state and federal agencies, and countless medical institutions with whom we might some day have to interface - how do we determine what specs to build for? 
 
In the great Chicago fire (I think it was), the city burned to the ground while firefighters responding from all over the state stood watching. There was no standard coupling on fire hydrants yet. Their hoses wouldn't fit the couplings. 
 
Same story today. We need a standard that everyone agrees to before the functionality will appear. It's not technologically that difficult. But it's a political football. Large vendors with lots of money are (as always) dominating the legislative advisory boards so that their way of doing things become the standard. This makes some sense, but such a process often ensures that the standards we accept will comply with design decisions made 20 years ago because the large vendors have old technology that would be very expensive for them to re-write. They lobby not for the best that's available today, but for what fits their installed base. 
 
As a nation our rush to promote (not to say "enforce") electronic medical records prior to establishing concrete, reasonable, efficient standards (HITECH, "meaningful use", common data exchange formats, etc.) means we will prod physicians into buying EMR's (with govt money) that were not built with the current (or any) standards in mind. Likewise, rewarding a vendor with high recommendation for having thousands of installations is in some ways tantamount to promoting old, non-standard technology. 
 
So. If we want software to meet requirements, we have to define those requirements not in broad-brush politically correct terminology, but in terms that make sense to those who architect the solutions. The nation needs well written, elegant standards for it's gee-whiz national electronic medical records system.

posted @ Wednesday, September 29, 2010 11:49 AM by Patrick J. Casey


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