- For nearly two decades, EHR implementation efforts at healthcare organizations big and small have included the “physician champion.” This is the bold and trusted ambassador who has embraced modern technology and who will lead the organization through its modernization. His value was especially apparent as healthcare organizations transitioned from EHR implementation to EHR optimization.
The clinical champion is held up to be all things to EHR adoption and optimization: requirements gatherer, system designer, vendor haranguer, clinician consoler, trainer, help desk, coach, and most importantly, change agent.
But what do you do when physicians no longer champion EHR optimization? What happens when clinicians give up on EHR vendors after trying to give them constructive improvement advice for a decade or more with little to show? What do you do when meaningful use-weary physicians find out that 962 pages of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) define their next era of practicing medicine and walk off dejected?
We face the completely understandable possibility that clinicians will not be the catalysts for the next period of play in the healthcare technology revolution.
The alternative is quiet, steady, subversive progress from the back office
The long anticipated healthcare technology revolution doesn’t look like the Arab Spring. It doesn’t look like industry shattering disruption like we have seen with Uber, Airbnb, and Spotify. By all accounts, so far it is a rather tepid revolution, but there are two clear areas of steady progress. Payers and provider organizations are together taking bold steps with payment reform and IT “insurgents” are quietly and relentlessly implementing systems and changing the information flows that surround the provision of care.
Here in Massachusetts, like in many places throughout the US, it is pretty clear what work we have to do from the back offices. It comes down to implementing four critical technologies and doing so in a way that anticipates well-known hurdles. It is not news that clinicians have difficulty with current EHR workflows, that they are intolerant of “too many clicks” and that they won’t willingly hop among multiple applications to piece together patient history. It is time to move on from this narrative and put the computers to work on the things they do well.
First, provider organizations require business and practice management systems that are flexible enough to deal with shifts to value-based purchasing. For the next few years most healthcare organizations will have to work with two or more radically different payment models, fee-for-service and a variety of alternative payment models, so it is important to pay attention to the transition. The business systems need to support organizations that are straddling two opposing ways of thinking about payment and expense management. The IT systems need to simultaneously help the business office keep the lights on as legacy fee-for-service contracts wind down while supporting a 180-degree shift to budgeting and risk management functions more typical to non-healthcare businesses. We will succeed on the payment reform front only if we can throw off the constraints of legacy payment models and implement cleaner and simpler healthcare accounting practices that steadily remove billing-related steps from clinical workflow.
Second, provider organizations require a means to exchange medical records with other healthcare organizations. In Massachusetts, providers have many exchange solutions to choose from: The Mass HIway provides secure transport of health information from one organization to another. More than 24 other Health Information Services Providers (HISPs) are interconnected with the Mass HIway and offer a broad network for secure messaging. We also have several vendor-based (e.g., Epic Care Everywhere, CommonWell) and region-based (e.g., Pioneer Valley Information Exchange, Wellport) that provide HIE services.
The most pressing job of the IT shops right now is to go beyond connectivity with the HIE service(s) and to automate the medical records management workflows. Clinicians absolutely need to be involved in the process of reconfiguring the workflows, but they don’t need to lead these efforts or understand the mechanics of information transport. Organizations can start with smaller, achievable goals like reliably serving up updated allergy and medication lists, patient history, and immunizations, and then build from there. Information triage tools are getting better, creating opportunities to better redefine supporting workflows as information starts to flow among healthcare organizations.
Third, provider organizations require a means to efficiently calculate and report clinical quality measures. Since real revenue is now on the line for performance, there are two imperatives for quality reporting: comprehensive data gathering (certified EHR technology can do some of this work but are often limited when patients cross from one healthcare organization to another) and tools to support clinical quality improvement initiatives. All signs are that more scrutiny is coming regarding adherence to evidence and best practices and to performance on a range of clinical quality indicators. Clinical teams will need information feedback loops in place as they pay more attention to quality improvement.
Fourth, provider organizations require a means to communicate electronically with patients. The patient expectation bar has been set pretty high by the non-healthcare industries. Patients want another way to communicate with their care team as well as convenient administrative functions for scheduling, referrals, and bill pay. They also want self-service access to their medical records for things like camp forms, immunization records, and help recalling lab values and care plan instructions. The patient portals that are included with Certified EHR systems show the greatest promise to date for engaging patients. Portal rollout requires design of new patient communication triage with clinical staff, wide scale promotion with patients, and rapid cycle tweaks to workflows to make the new communication channel work for, and not counter to, the efficiency of the organization.
Physician champions welcome!
Healthcare technology modernization projects simply go better when clinicians are involved, and while we are optimistic that the “clinicians will come” once the IT fundamentals are all built and configured, we don’t know for sure. In any event, there is really no other option. If clinicians don’t champion and the back offices don’t step up, we are left with the unsustainable status quo that is the U.S. healthcare system. In an ideal world, the clinical champions will continue to lead the charge, but we can still make steady progress even when they decide that they need to sit on the sidelines for the next period of play.
Mark Belanger is the Director of Advisory Services for the Massachusetts eHealth Collaborative. Mark has helped plan, launch, and advise several large scale health IT programs including the Massachusetts statewide HIE (Mass HIway), the New Hampshire Health Information Organization (NHHIO), and the Pioneer Valley Health Information Exchange (PVIX).