John Halamka, MD predicts value-based care will usher in a new iteration of EHR technology geared toward improving usability and patient satisfaction.
Beth Israel Deaconess Medical Center CIO John Halamka, MD, MS, predicted EHRs are headed in a more patient-centric direction with a focus on improved usability.
In part, Halamka attributed the upcoming shift in EHR design and use to eClinicalWorks’ $155 million lawsuit.
In Halamka’s eyes, the recent stir surrounding eClinicalWorks offers proof that EHR selection should not depend on vendor popularity, marketing strategies, or industry trends.
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Instead, healthcare organizations should focus strictly on whether products and services meet necessary requirements.
“As an engineer, I select products and services based on requirements and not based on marketing materials, procurements by other local institutions, or the sentiment that ‘no one gets fired by buying vendor X,’” wrote Halamka.
Halamka framed upcoming changes in EHR requirements as a shift from “EHR 1.0” to “EHR 2.0.”
Whereas EHR 1.0 merely facilitated data storage for easier billing and government reporting, EHR 2.0 will focus on improving care delivery and patient satisfaction.
The healthcare industry is becoming an environment ripe for technology designed to holistically improve health outcomes rather than simply store patient data.
Halamka added that a lessening of government mandates is likely to be a catalyst for these changes.
“The era of prescriptive government regulation requiring specific EHR functionality is ending,” he wrote. “In my conversations with government (executive branch, legislative branch), providers/payers, and academia, I’ve heard over and over that it is better to focus on results achieved than to do something like count the number the CCDA documents sent via the Direct protocol.”
Halamka encouraged providers to assess EHR technology based on the specific needs of their practice and community.
“Suggesting that one size fits all in every geography for every patient no longer works as we move from a data recording focus (EHR 1.0) to an outcomes focus (EHR 2.0),” he said.
Communication and care coordination will also be key to thriving in a value-based care model. Teams of clinicians need to be able to communicate efficiently to coordinate healthcare delivery while meeting federal incentive requirements.
“A team of people is needed to maintain health and a new generation of communication tools is needed to support clinical groupware,” stated Halamka.
“We need automated clinical documentation tools that record what each team member does and then requires a review/signoff by an accountable professional, not writing War and Peace from scratch until midnight (as is the current practice for many primary care clinicians),” he added.
As value-based care replaces fee-for-service reimbursements, EHR use and selection will change accordingly.
“Our electronic tools for EHR 2.0 should include the functionality necessary to document care plans, variation from those plans, and outcomes reported from patient generated healthcare data,” wrote Halamka.
Software would include a care management health record rather than a standard patient health record and incorporate protocols based on symptoms and diagnosis paired with patient relationship management concepts.
“ICD-10, CPT, and HCPCS would no longer be necessary,” he predicted. “Bills will no longer be generated. Payments would be fixed per patient per year and all care team members would be judged on wellness achieved for total medical expense incurred. SNOMED-CT would be the vocabulary used to record clinical observations for quality measurement.”
Halamka also addressed how EHR developers can improve usability in future models.
“My view is that EHRs are platforms (think iPhone) and legions of entrepreneurs creating add on functionality author the apps that run on that platform,” he said. “Every week, I work with young people creating the next generation of highly usable clinical functionality that improves usability.”
Finally, EHR 2.0 will be consumer-driven and patient-centric.
New care delivery models such as at-home monitoring, convenient ambulatory locations, urgent care clinics, and virtual visits will bring care to patients in more diverse, accessible formats than ever before.
“Although existing EHR 1.0 products have patient portals, they have not made the patient/family an equal member of the care team, providing them with care navigation tools,” stated Halamka.
Providers will also benefit from technology that functions more like a social networking website. EHR 2.0 will promote provider communication and care coordination with easily-navigable interfaces.
“After nearly six decades of work on EHR 1.0, let’s declare victory and move onto social networking-like groupware supporting teams of caregivers focused on value while treating patients as customers using mobile and ambient listening tools,” concluded Halamka.
Date:June 08, 2017