Tuesday, October 13, 2015
As public and private sector health care providers move to integrate electronic health records, challenges to implementation continue -- but the benefits to agencies, providers, and the public will be significant.

Listen to the interview with Keith on Federal News Radio. Transformation is a challenging process, sometimes painful. Healthcare transformation seems to be one of the most challenging, and painful for the workforce likely due to the many stakeholders, complexity of information, need for trust and privacy and so on. Indications that the industry is moving up the curve from high cost/low productivity solutions toward low cost, highly effective solutions that bring real gains in productivity, accuracy and enable the goals of delivering better healthcare and health are starting to appear. Incentives to drive change, such as the Center for Medicare And Medicaid Service’s reimbursement move from Fee for Service to Outcomes from CMS are taking hold; throughout the health sector, Electronic Health Record (EHR) adoption is reaching near complete penetration. The Challenge to EHR Adoption While the first generation of Electronic Health Records provided 24/7, legible access to patient information, low usability and a high level of effort required to operate them leave the healthcare workforce and patients/caregivers dissatisfied, particularly in the face of digital ease in smart phones, banking and other transformed industries. The task lists for physicians continue to grow and are addressed with less than helpful tools: Electronic Health Records (EHRs) that require more effort to support than the value they deliver Meaningful Use (MU) requirements that, while well intended, are not easy to satisfy with the current tools and ecosystem in place Cumbersome referral and claims processing that add additional workload and lead time to physician offices and care delivery platforms that are losing margin or going into the red to keep current More time spent feeding the administrative demands than working with and caring for patients and their caregivers Opportunities to Move Forward Even with these challenges, incremental gains leading to innovation and significant progress are evident and getting closer to reality. The move toward the inflection point of transformation in healthcare reflects the normal progress in transforming industries, which is slow -- and eventually accelerates to the point of widespread gains, adoption and improved effectiveness. One example includes a program in New York benefiting patients on Medicaid. The Electronic Medication Management program was created so that when patients transferred to a new health care setting, and there was an increased risk of medication errors due to incomplete or inaccurate medication information, that the medication list documentation and communication remained intact. Medication reconciliation employs a systematic approach to reviewing the medications a patient is taking, and comparing them to what has been ordered for the patient in order to identify and resolve medication discrepancies. An EHR system was already in use, but modified to include an Outpatient Medication Profile (OMP), a structured, longitudinal electronic medication list shared across ambulatory and inpatient EHRs. Before the electronic medication reconciliation process was adopted, the average number of medications contained in the OMP for a patient at hospital admission was less than two. One year after adoption, the average number had increased to 4.7. The new system also included reminder intervention tools such that medication use was confirmed upon hospital admission within 5.3 hours instead of 9.2 hours.[1] Now that widespread adoption of EHRs is the norm, (HHS reports that “more than 8 in 10 physicians have adopted an EHR" and “as of April 2015, 95% of all eligible and critical access hospitals have demonstrated meaningful use of certified health IT through participation in the Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Programs.”[2]) the task at hand is moving from paper information in paper records, convenience files, and documents lost in transition, and to re-engineering the workflow surrounding electronic systems in the practice of medicine. Physicians and clinical/administrative personnel, and even patients, have an opportunity to shape how the adoption of electronic systems will change to enhance the user’s experience-Stakeholders who have energy, insight and interest should look for opportunities to contribute to the next generation capabilities that will advance along the transformative continuum. Taking innovation from other industries and adapting it (not just transposing it) to healthcare leverages the greatest form of flattery -- imitation. For example, Imagine Apps and similar tools that function intuitively have minimal latency and down time, and move the level of effort from the user to the tool. Other paths for EHR innovation in government are outlined in a recent report from the Center, “Making Open Innovation Systems Work: Case Studies in Healthcare." This report describes relevant case studies from the US Department of Veterans Affairs and the West Virginia Department of Health. Emerging payment reforms from fee-for-service to outcomes and value will help drive the change from a piece-work approach to business value, resulting in patient and provider satisfaction. Even as implementation details are being worked out, the demand from the user community will move advances in automation to improve service now that a basic infrastructure is in place, and as that infrastructure improves. Driving Benefits to Health Care Delivery from EHRs Whitespaces in terms of opportunities to engage patients where they live and breathe (rather than limiting to fixed facilities), creative points of interaction between the healthcare delivery system and patients, and ways to engage patients in their health are emerging from the fog of MU, EHR adoption and payment reform. Giving providers and healthcare workers tools that enable them to care for their patient populations will drive satisfaction in the workforce and translate into increasingly satisfying patients -- a long awaited improvement in the healthcare ecosystem. Medical professionals can look for ways to engage in forward movement or, encourage those who have the energy to drive transformation in healthcare to the next level of performance. [1] HHS’s Agency for Healthcare Research and Quality, https://www.healthit.ahrq.gov/ahrq-funded-projects/electronic-medication... [2] HealthIT.gov Dashboard, http://dashboard.healthit.gov/index.php ** Image courtesy of anankkml at FreeDigitalPhotos.net