EHRs: Getting all the Systems to Play Well Together

Co-authored by Ann Mendlowitz, Director, Provider Solutions

Did you see the title above? If ever there were a statement in health care, that’s the one.

A few questions and an observation:

  • Can we ever achieve having all the systems play well together?
  • Will we ever see success in getting one Electronic Health Record (EHR) vendor system to play well with another vendor’s system?
  • It’s more than just interoperability, which is often lacking, according to Medical Economics.

While EHRs are sometimes the primary application at the point of care, they often don’t connect to new technologies. Integrating with other EHRs, population management, lab, and pharmacy systems requires custom interfaces; there also needs to be a place for the data to go in the new EHR fields and workflows, the Medical Economics article said.

What’s missing?

Let’s say you are a physician whose practice recently implemented an EHR, as part of its affiliation with a larger health system.

Now, let’s say you have a patient and you need to check on some recent lab work. It may be almost impossible to get that information from the other system and into the EHR.

Why does it have to be so difficult? you ask yourself in complete frustration.

You may climb over many hurdles, and you may be successful in getting the information, yet it most likely won’t be in a format that’s helpful, actually, it may be more like a summary than actual information you can act on.

Black Book Market Research recently reported that 41 percent of hospital administrators have difficulty exchanging EHR information with other providers. Twenty five percent of the respondents said they can’t access any patient data from external sources.

More than 3,300 EHR users surveyed show:

  • 70 percent of hospitals aren’t using patient information outside of the EHR, because the provider data is missing from their EHR workflow
  • 22 percent of medical records administrators said the information that was transferred wasn’t in a useful format
  • 82 percent of physician practices weren’t comfortable that their EHRs had the connectivity and analytics needed to manage the risk requirements of accountable care

If one of your patients has been discharged from the hospital, you may see that activity in the EHR, but you may have no idea what’s in the discharge plan, or whether the patient will see a home health nurse, first, or if the patient is being transferred to a rehab facility before heading home.

Often this level of information is missing.

One EHR vendor may capture the information, but sharing it becomes burdensome. Another EHR vendor is easy to work with if they’re getting information from another health care organization who has the same technology. For example, two large health systems running the same EHR will find it easier to get the information they need. When it’s two health systems using two different EHR vendors, though, that’s the rub; getting the information that’s needed is difficult.

In theory, EHRs are supposed to improve care coordination and get all of the information that’s needed into one place. The Office of the National Coordinator for Health Information Technology (ONC), says each member of the care team has a specific, limited interaction with the patient, and a different view of the patient. “In effect, the team’s view of the patient can become fragmented into disconnected facts and symptom clusters. Health care providers need a less fragmented view of patients,” ONC says.

Interfaces can get at the data, but some vendors have taken it upon themselves to create their own care management systems that extract more data from the EHR and get at the information that’s needed.

Building a solid population health and care management environment means that the systems must work together to collect data from claims systems, the EHR and other sources. A population health management system gets the important data from the EHR for operations, cost reductions, increased satisfaction and quality improvements.

Playing well together

The analogy we like to use is that it’s like four kids playing in a sandbox and there are only three toys. How will they negotiate this? In health care, how can the systems play well together and share data?

An Accountable Care Organization may drive data sharing to some degree. But questions remain, including:

  • Can a provider trust the payer with the information?
  • What trust issues have to be overcome?
  • How does the vendor respond when the provider says they’re concerned that data will be lost — or worse — hacked?

These are all valid concerns, but ones that can be addressed through collaboration.

Attention also needs to be paid to physician documentation at the time of authorization. What if a physician is a poor documenter? What if the payer isn’t able to get an authorization because the documentation is poor?

A doctor may be excellent at caring for patients, but his documentation is lacking. Maybe the physician’s pre-authorizations are being denied because he needs to document better.

The doctor may say he’ll talk to the health insurers medical director to explain the documentation, however this may negatively effect and cause their Relative Value Units (RVUs) to drop.

The physician needs support in their documentation to get to higher RVUs [see our earlier blog on RVUs and the Goal of Creating a Patient-Centric Care Experience] and ensure that the money is being distributed appropriately.

Overcoming the concerns

What if we were able to open up the information? Maybe the doctor isn’t the best at documenting his interactions with patients, but he’s an excellent physician with a solid track-record.

Would we overcome the data sharing issues if the insurer were able to look at the information in the EHR and see what the doctor had done? There’s a concern that the payer may make a random decision that negatively affects the provider.

One way to overcome these issues is by having access to the EHR. Let’s say the physician requests an authorization for a patient having bariatric surgery. The physician states that the member met the criteria with InterQual or MCG Care Guidelines, however, no documentation is provided to support their request and claim.

If the payer had access to the EHR, they could look at the lab work, dietician comments, psychology reports, etc., so they would not have to ask the doctor to provide further documentation because they could look for the information themselves. This would save time in the authorization process that, today, can take up to two weeks.

Overcoming these concerns and getting the systems to play well together is something we believe can be accomplished.

Co-authored by Ann Mendlowitz. Ann is Director, Provider Solutions