4 reasons EHRs aren't built for value-based care
Over the last decade, we have witnessed the digitization of healthcare through the implementation of Electronic Health Records (EHR) in nearly every doctor’s office around the country. EHRs were initially celebrated for improving data accessibility, easing the documentation of patient information, improving billing accuracy, accelerating processes and more.
EHRs were designed to support a fee-for-service (FFS) reimbursement model by electronically documenting patient encounters and translating those activities into billing codes. Providers were required to adopt a certified EHR system to qualify for an incentive payment under Meaningful Use and, not unsurprisingly, many took advantage. But as we all know, FFS is on its way out and value-based care is on the rise.
As a result, provider businesses are being asked to deal with FFS and value-based care, and yet EHRs were not designed for success in a value-based world. Healthcare is evolving and the EHR isn’t built to evolve with it. Instead, it’s built to drive revenue cycle management and clinical operations in an appointment driven workflow. This transition away from traditional uses and into value-based care is driving providers to enhance the critical functionalities that EHRs provide and look to other tools and solutions on top of EHRs to enable and succeed in value-based care.
In this first part of a three-part series on EHRs, we’ve outlined some of the limitations of EHRs in supporting population health management and the transition to value-based care. For providers experiencing these pains, it may be time to consider an alternative strategy or complementary system to augment population health efforts.
Patient Stratification & Analytics
According to a PwC study, 75% of healthcare executives don’t believe their EHR technology will help meet the demands of population health management, citing a lack of data integration and analytic models as a major inhibitor.
Effective population health management requires visibility into high-risk patients in need of an intervention. To do this, healthcare providers must aggregate and analyze data from a variety of sources—hospitals/physicians, specialists, ancillary providers, social determinants of health, etc.—to clearly identify the right actions to take for the right population cohorts to ultimately improve health outcomes. While EHRs are great for data collection, they lack the functionality to make that data actionable by proactively bringing potential problems to the surface and providing steps to mitigate them.
EHRs revolutionized the patient experience by allowing online access to medical records (through patient portals, for example) and by digitizing processes, such as making appointments. For providers, the user experience still needs improvements. While EHRs function well as a repository of information, they do not help identify the right path forward based on the entire view of a patient’s health (beyond what’s shown in the EHR). This is still a largely manual process requiring submission of clinical queries within the EHR. “Search and find” supports the appointment driven workflow nicely but leaves much to be desired in Population Health.”
Once the right patients and interventions have been identified, population health management emphasizes the use of evidence-based care plans to address patient need(s). With treatments and care guidelines changing frequently, it can be difficult for physicians to keep up with best practices. Hence the need for technologies that analyze outcomes and the latest research to provide the ideal care plan for a patient. EHRs function well in an appointment-driven environment but aren’t necessarily equipped to guide care delivery decisions.
Interoperability & Data Sharing Restrictions
The average number of distinct EHR platforms that a health system uses is 16. Most health systems have at least 10 EHRs in place among affiliated and specialty providers. Not only does this make interoperability difficult, but it also makes it necessary. If providers within the same system on different EHRs cannot share information about patients, how can they effectively care for them? And what about care that occurs outside of that particular system?
As mentioned earlier, a key tenet of population health management is information-sharing among disparate providers in order to get a holistic view of a patient’s health. In addition, effective population health management requires using that information to identify opportunities to communicate with patients outside the four walls of a hospital or physician’s office, in order to support caregiver engagement, medication adherence, appointment follow-up, and more. That’s difficult to do across so many different systems that cannot communicate with one another.
And yet, most EHRs are limited to integration with other users of that particular EHR or their own proprietary applications; There is little to no interoperability with other EHRs, health plans claims systems, care management platforms, lab and pharmacy information platforms, and so on. If a behavioral health provider wants to collaborate with a hospital on preventing and treating opioid addiction in their communities, and the behavioral health provider is not on the same EHR as the hospital, the two most likely end up using paper and fax—a largely manual and administratively difficult data sharing process that hinders progress towards improving outcomes.
Overcoming this limitation involves deploying an EHR-agnostic solution that enables the flow of healthcare data between every member of a patient’s care team, connecting the patient experience across care settings.
In addition to tracking progress against evidence-based care pathways, succeeding in population health management requires measuring and reporting on performance, including increased quality of care, lower cost and better outcomes. This information is not typically captured in an EHR or presented in a way that’s easy to report.
When you dive further into value-based care and the requirements for Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs), the need for tracking performance becomes even more crucial. It’s difficult to show success in improving the health of your populations if you don’t track improvements in quality, cost and outcomes.
Want to see the power of a population care management solution at work? Download our case study learn how Texture Health and Medical Home Network (MHN) are improving patient outcomes in a resource constrained environment.
When EHRs were first introduced, they were positioned as the one-stop-shop for all things patient care. They solved an immediate need to digitize patient records and improve efficiencies in provider billing, allowing physicians to focus on better caring for patients. But times have changed and it’s becoming evident that EHRs simply aren’t enough to organize around population health management.
In today’s healthcare world, EHRs are often just one of many tools to equip providers with the information they need to manage the cost and quality of care for patients. In the next part of this blog series, we’ll introduce the care management platform and how it can help you overcome these challenges.
To learn more about how Texture Health supports your value-based care strategies, contact us to schedule a demo.
Purchasing a care management platform? What you need to know
Care management platforms were developed because healthcare leaders saw that EMRs were largely built for an outdated “fee-for-service” model. In an ideal world, care managers would have a single platform that would keep track of all necessary information about a patient to enable value-based care.
As a care manager, you know how dangerous it can be when you see conflicting data about the same patient, from various systems. But you must figure out how to let data empower your workflow, not prevent you from doing the best possible job for your patients. Read on for tips on how to do that.