EMRs – Meaningless Use?
By Mary Tucker
March 26, 2019
I read with interest Fortune magazine’s article about electronic health records (EHRs) and how they have not lived up to the promise they heralded back when our economy was bottoming out and the Obama administration allocated stimulus money to their adoption. It was a gold rush ten years ago in Health Technology, and as the article points out, not only has it not lived up to the promises, but in fact safety issues are mounting as a result. The company eClinicalWorks (eCW) took the brunt of the heat in this article. My company, UPIC Health, can certainly attribute many challenges with eCW in our own shop. But is it entirely the fault of EHRs? I don’t think so. And is there a way out without throwing out all the time and effort that’s gone into them over the last 10 years? Most definitely yes!
We’ve witnessed these tech gold rushes before in other industries and have experienced disappointing results. There is a significant missing link that is acutely resolvable once identified: Intention. Tech Sector is very young and yet across all industries and all demographics, we have submitted ourselves to it without taking the time to understand its purpose and use to human beings. We expect technology to solve big problems with the press of a button. We expect coders to understand the intricacies of business process and miraculously create a turnkey solution that all will adopt with an emailed description and a link to sign up. That may work for Angry Birds, but cardiac interventions – not so much.
Health technology – like any technology – should be employed to facilitate meaningful human connections.
Chasing down a lost pharmacy submission is not meaningful – its operational (and necessary). Understanding why the pharmacy submission got lost is more critical and imperative BEFORE launching any technology to understand and have documented the operational business processes as they are today and what the dream state would look like with the use of technology. Patient touch-points (such as phone, web, email, portal, front desk, back office, pharmacy, lab, etc.) should be evaluated and the patient process documented; compliance processes for each individual in the chain should be evaluated for opportunities to simplify, and exceptions should be understood.
Ten years ago, though, who had that kind of time? The economy needed stimulating, and in hindsight (despite Fortune’s poke in the industry’s eye) it’s still a good thing the gold rush happened. The new question is “now what?” You have spent millions on your EHR – do you just toss it out and start over? (Interestingly, I had an outpatient procedure a week ago and the entire process was on paper…) However, it is not worth abandoning the train when you’re halfway to your destination.
First, I recommend you start with your patient processes – spend time in your contact centers listening to calls, chats, portal interactions, and emails. Are your patients bounced around from group to group depending on what their need is? Are they calling and emailing multiple times to get their questions answered? That’s your first opportunity to identify your first Intention – minimize the steps to care for the patient! Remember – the greater the patient effort, the greater the cost to you. This focus will help you map how you want your EHR technology and make access to care smoother for the patient. This mapping can then be documented and submitted to tech development teams to use as their guide. Following, I offer these recommendations:
- Identify your first Intention (minimizing the steps patients must take to access care).
- Look at your Revenue Cycle Process – how much are you paying your EHR vendor and what percent of your claims have been denied and why? Begin with the Intention to understand the steps to cash to help identify current state and where the failures are happening.
- Observe the uses of EHR by clinical and administrative staff throughout a care scenario – what failed? Where and why did it fail? What would the perfect process look like? Your clinical and admin staff will tell you.
- Be Intentional about interoperability – if we know we haven’t cracked this nut yet, don’t expect the nut to miraculously crack on its own. Know the process for referrals as it is today and determine if there’s a midway point between your EHR, your staff, other providers in your network, and your patients. Think of bringing in a lean six-sigma team now who can do this work for you – this is what they do and it is worth the effort.
If you sustain your intentions to simplify with the understanding technology should facilitate meaningful human connections – and you have a view into where those connections have no meaning or value – you’ll be in a position to identify what you need in your EHR, what you’re missing, and a road map to repair.
Mary Tucker is CEO of UPIC Health, a contact center and revenue cycle management outsourcing firm focused on meaningful engagement in care. UPIC Health is based in Chantilly and Norfolk, Va. Follow us on Instagram and Twitter @UPICHealth.