- While the entire healthcare industry is gearing up for value-based care, several gaps persist throughout the continuum of care that could slow this transformation. One obvious hole to be filled is the lack of EHR interoperability which not only exists between healthcare organizations but also within these very own healthcare organizations themselves.
"Ideally, I would like to go into my EHR and then when I needed something from someone else’s, I’d be able to easily tap into their EHR and look at it and pull out whatever information I needed," Advocate Contact Center Medical Director Jennifer DeBruler, MD, tells EHRIntelligence.com.
Physician-led Advocate Medical Group created the center back in 2014 in order to streamline communication among providers, patients, and office staff. Its existence signals the challenging reality of trying to coordinate care as part of a complex health system that is AMG.
"Some of the biggest challenges are the different EHR systems everyone is using and there isn’t necessarily one link from the hospital to the different doctor’s offices that connect everything," DeBruler explains. "You don’t really have access to all of the information when the doctors are not part of your medical group, per se. That is difficult. There are some things set up, but it certainly isn’t perfect."
Concomitant with these technical barriers to EHR interoperability are the difficulties associated with physician-to-physician communication
"We’re all trying to see as many patients as we have; there is a lot of demand," DeBruler continues. "The process of trying to get a hold of other physicians and their offices, to get documentation and counsel, is a big barrier to getting the information."
The efficient exchange of health data is key feature of coordinated care. This exchange, however, easily becomes strained as health systems expand to include both affiliated and non-affiliated physicians.
"Within our own system, we have access to the same EHR," DeBruler reveals. "In the hospital, they use a different product, but they have a link for us to reach the hospital. But there are other people who work at Advocate, specialists or even other primary care doctors, who may have been taking care of a patient and are not part of our group. Their office information is not accessible to us unless we call their offices and have them fax it to us."
Value-based care serves to heighten these inefficiencies, even in an integrated environment.
"Being part of a big medical group, our clinical integration is connected via the computer, but it is not foolproof," DeBruler maintains. "There is some manual tweaking that has to go on to make sure that everything gets in there and that it is accurate for each patient. It takes a lot of work and manpower to do that."
Despite increased awareness of the need for EHR interoperability, technical gaps between EHR systems require manual solutions.
"We can have medical assistants or nurses working on lists of patients that they are wanting information from," says DeBruler. "It is a manual process to either call, for example, the ophthalmologist office to get an eye exam or maybe something didn’t get linked from our own computer system into theirs, like a glitch or entry error that doesn’t allow it to flow over."
It comes as little surprise then the benefit of keeping patients in-network for the sake of efficiency.
"As physicians we do recognize the benefit of keeping patients in network and we have high-quality physicians who work at our practice. We do try to keep patient in our network as much as possible for all the benefits that you get from that," adds DeBruler.
Until the healthcare industry removes barriers to health information exchange, the onus is on members of office staff to prevent errors and improve the accuracy of patient data.
"There are lots of hours when people are working on this that have nothing to do with taking care of patients. It’s more just combing the data to make sure it’s in there," DeBruler concludes.