The Centers for Medicare & Medicaid Services (CMS) announced last month that it was rebranding its familiar electronic health record (EHR) Incentive Programs from “meaningful use” to “Promoting Interoperability.”
Among the proposed changes are welcome simplifications in reporting protocols, as well as new requirements surrounding EHR capabilities. Specifically, these new requirements seek to improve pricing transparency, facilitate the sharing of patient information between providers, and further engage patients in managing their care. To accomplish this, all eligible providers will be required to demonstrate compliance with 2015 Edition of CEHRT by next year.
Which is great – these are excellent and important changes, and I am anxious to see how they could positively impact my patients. On the other hand, I worry that in focusing on external interoperability, healthcare providers will ignore the value of internal interoperability.
External Interoperability
To clarify, when I say external interoperability, I’m referring to the type of interoperability that CMS is currently emphasizing. Specifically, a hospital or health facility’s ability to communicate clearly and securely with external EHR systems and their patients.
There is significant room for improvement in external interoperability. According to Black Book Research, 36% of medical record administrators report struggling to exchanging patient health records with other providers, particularly physicians not on the same EHR platform. A further 24% report that they are still unable to access meaningful patient information received electronically from external sources.
These types of provider to provider communication is extremely important. Sharing patient data across providers and EHRs results in better care coordination, with fewer redundancies in testing and treatment that play a large role in the patient experience. Similarly, giving patients access to their health data significantly improves patient-provider communications, which can in turn affect health outcomes.
So yes, external interoperability is extremely important. But I worry that focusing exclusively on these capabilities will pull the focus away from something most EHRs still struggle with today – internal interoperability.
Internal Interoperability
Like most physicians, a significant portion of my day is spent interacting with an EHR. Tools which allow us to effectively manage the patient are always appreciated. We want the EHR to work with our workflow not against it.
Perhaps this focus on my own EHR user experience seems short-sighted, but there are significant benefits to patients as well. Specifically, I must be able to quickly analyze the different data available to make an educated decision concerning the patient’s healthcare.
For me, one of the most important elements to a successful EHR is internal interoperability. By that, I simply mean an EHR that allows easy access to the wealth of information presented to us on a daily basis. This can be as granular as minimizing clicks throughout a workflow, and as complicated as the integration of relevant external data into a record which may make a difference in the management of the patient.
Some of the features, over the years, that will help with improvement of interoperability and better use of an EHR may include:
Fewer Screens
I have never been a fan of requiring more than one screen to document. Worse, having to open up the same patient record on each screen and then the sub-folders. Losing time by clicking back and forth, mistakenly selecting the wrong tab or patient, reduces my efficiency and productivity, especially on a busy day.
After joining Cantata, I was very pleased that our documentation module allowed the user to accomplish his or her work on one screen. Information was available without leaving the module which is common in some other systems.
End-to-End Integration
Not only do I expect the systems I use to integrate well with each other, but they should just as easily import data from external systems as well. I don’t want to enter the same information into the same (or even separate) systems multiple times. If I enter or update important patient data, I expect that data to populate throughout the system.
Similarly, I want to be able to view EKGs, pulmonology studies, imaging results, and historical data on the same screen. Tabs should be well demarcated that direct me to the studies I need. And an efficient EHR will avoid searching for paper results not in the electronic record. We should be able to view everything in one sitting.
With our EHR at Cantata Health, we have placed a premium on seamless communication between systems and solutions, which CMS has defined as absolutely necessary for improved interoperability.
Two-way Communication
Improved communication between individuals is one of the key advantages users can expect from better integration between systems.
Let’s take a long-term acute care hospital (LTACH), for example. LTACHs have many specialized communication needs, from pre-admission screening to ongoing family communication. Cantata Health’s web-based LTACH solution allows for web-based screening documentation that can be completed on a phone or tablet, and ready for financial review in minutes. In some cases, the review is completed before the screener leaves the hospital, and they’re able to inform the patient of their eligibility in person, in real-time.
Similarly, Cantata Health’s Family portal allows LTACH providers to communicate directly with their patients’ families. Providers can instantly share updates, documentation, forms, and test results to various family members, who can then choose to securely share this information with additional family members. This allows the family to take a more active role in their loved one’s care, which decreases stress and improves patient outcomes.
Endless Customization
I truly believe that EHR customization should be quick and easy. Updates that improve the physician workflow shouldn’t take months to implement. Similarly, physicians should be able to customize admissions, run specialized reports, develop individualized order sets, and even create their own personal templates.
At Cantata Health, we want to empower the physician to utilize the EHR in the best way possible that fits his or her workflow. As more modules and more tools become part of the EHR, this ability to customize how they integrate with each other will become more important in the near future. Physicians will need the ability to decide which parts of an EHR will allow them to improve their workflow and results. A one-size-fits-all solution is no longer acceptable. In the future, physicians will demand a flexible, adaptable, integrated EHR that prioritizes both internal and external operability