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How the EHR Selection Process Influences Specialist EHR Use

A study of pediatric EHR use found communication gaps between EHR vendors and providers leading to poor EHR design and limited usability.

By Kyle Murphy, PhD

- Key to a successful EHR selection process is meaningful use dialogue between providers and EHR vendors. This is especially true for specialists for whom fewer EHR products are designed and available.

Kern Eason of CCNC on pediatric EHR use

That is one of several takeaways from a five-year study of pediatric EHR use by Community Care of North Carolina (CCNC) with the goal of defining a model EHR design for pediatricians. CCNC was the recipient of a Children's Health Insurance Program Reauthorization Act (CHIPRA) grant to improve care quality of Medicaid and CHIP beneficiaries.

Kern Eason, Pediatric EHR Consultant at CCNC, was part of the research team led by Marian Earls, MD, to evaluate EHR vendors and pediatric EHR technology and their role in impacting clinical quality.

In a one-on-one with EHRIntelligence.com, Eason identified several obstacles in the way of improve pediatric EHR design and use, none more so than provider-vendor communication during the EHR selection process. For pediatricians in small or rural practices, the ability to gain adequate knowledge of various EHR systems can be overwhelming, an outcome Eason and his team hope to avoid by sharing findings from their five years of research on pediatric EHR use.

EHRIntelligence.com: How did North Carolina stack up to other quality demonstration challenges on EHR use?

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Kern Eason: North Carolina took a different approach to Pennsylvania which tried to use this huge model format that had over 700 unique requirements and evaluate it in five of their hospital systems. That included inpatient and outpatient settings. Obviously there were different EHR vendors, more of your large system vendors. Because CCNC is working with rural and smaller providers — we do work with hospitals as well — we worked with EHR vendors who really targeted those types of practices with their EHR systems. Fortunately for us, we had two of the major pediatric EHR vendors on board with this project. They saw in this project a real value in looking at what clients are needing, where are the gaps in the system, and how are clients using a system designed for adults are able to compete and succeed versus a pediatric-specific EHR.

One of the biggest takeaways for us was that EHRs are very sophisticated and evolving at an incredibly rapid pace and providers can't keep up, especially solo provider practices or practices already stretched that way. They are not able to go in and consume all the guidance on new features and capability. As they were going through our survey approach, looking at this model format and seeing if their system could do this, that was the big takeaway: They would love to have more knowledge of EHR vendors and products to create a dialogue.

Pediatric EHR use in NC

EHRIntelligence.com: Given the focus on primary care EHR, do pediatricians suffer the same fate as specialists in terms of the limited availability of EHR products? Are pediatricians in a sense specialists from this perspective?

KE: Absolutely. That was for me one of the most exciting things we were able to do with this grant — to not only impact the way these EHRs are deployed in local practices but to also think more broadly and help EHR vendors understand that this is something that will help improve the product you offer to clients, improve customer satisfaction and retention, and tie into meaningful use and a lot of the other value-based directions healthcare is going. Vendors that saw that were able to jump in and make this a change agent in better catering to their pediatric clients.

EHRIntelligence.com: Who shoulders more of the blame for poor communication between EHR vendors and providers?

KE: There's a huge gap there. I sat in on a sales presentation giving by an EHR vendor, and there was a disconnect. I knew the practice well enough to know what they were trying to accomplish in terms of the bar they were setting for quality care delivery. The vendor sales rep was saying, "The system can do that. It can be developed to do that. It can be customized to do that." But they didn't realize the heavy lifting it would be for the practice to customize a system to that level. Knowing the practice's capabilities, I knew that they were really looking for a solution out-of-the-box that would work for them. I was able to have a follow-up conversation with that practice to say, "Based on my knowledge of EHRs, take a look at a couple other systems I feel are a little more aligned with your care and business strategy."

It made much more sense for them to go that route. Oftentimes, providers don't know what they don't know. The burden was really on both the provider to ask the question in the right way so that they didn't incur additional costs for training and the vendor to not break their business model but think about basic satisfaction for the core services they provide. Having that conversation and looking at these practices as learning centers for the vendor to test whether their products are meeting those needs is really important.

EHRIntelligence.com: How important is getting pediatric EHR design right to establishing longitudinal records and enabling health information exchange?

KE: It's so important. There are a couple areas that an EHR system can benefit. When we looked at this grant, we saw it as an opportunity to not only improve the EHR systems being deployed but also keeping in mind the purpose. This was a quality demonstration grant. Can we improve quality or demonstrate that care quality is improved by having a better EHR system? That's what meaningful use was all about, but we got lost in the weeds of meeting all those measures, having a certified system. But at the end of the day, it's about that longitudinal record and using that information not just to do population health but also the individual patient.

Structured data and the ability to coordinate care is a major weakness of EHRs. The latter tends to be very episodic unless there's a referral to a specialist, for example. More and more providers are realizing that they are a part of a community of care and now need to make sure they have the right information at their fingertips to provide the care they have been tasked with and incorporate care that has been received in other places.

As part of CCNC's model, we worked a lot with our informatics center and HIE to identify the critical pieces of information we need to collect that can help with that care coordination. EHR vendors also have some responsibility for that — to be able to make the referral management and tracking systems more robust.

EHRIntelligence.com: Now that the grant is complete, what's next for studying pediatric EHR use?

KE: A lot of times, grants tend to be one and done — the money is gone and the work is over. Dr. Marian Earls was the project lead and I still report to her here at CCNC as acting pediatric program director. From the very beginning, sustainability was a big part of how we look at this grant. This could be a real investment in pediatric programs across North Carolina at CCNC.

Image Credits: Thinkstock



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