A handful of influences in healthcare are converging and will necessitate a new way of thinking about EHRs. The new reality is that EHRs, rather than simply supporting the coding of billable transactions, must provide tools for the management of a patient’s health––preferably at the point of need––and involve all resources in the community who participate in the care of a patient.
Consider the following and their influence on EHR functionality:
- 21st Century Cures Act & TEFCA
The 21st Century Cures Act requires eight types of clinical notes that must be shared and accessible to patients. The Trusted Exchange Framework and Common Agreement (TEFCA) provides a framework for sharing of medical information. Both programs require compliance, and enforcement penalties can range from a monetary fine to suspension from Centers for Medicare and Medicaid Services (CMS)programs.
- Widespread acceptance and adoption of FHIR as a method for exchange of medical information
The Fast Health Interoperability Resource (FHIR) provides a mechanism for transmission and receipt of medical information that is now widely used as the “container” to package and send clinical data between systems and enterprises. Once this data is shared between disparate systems, clinicians must be able to locate and use information they need when caring for a patient.
- Software as a service (SaaS) and API-based interoperability
The demand for new functionality and the need for compliance with new requirements continue to grow. In response, the industry is moving toward providing more best-of-breed solutions to address specific needs such as quality measure compliance, and documentation and management of hallmark indicators for chronic conditions. This trend is accelerated by the “opening up” of existing systems to provide API-based interoperability, accessed “in the cloud” and available without extensive modification of existing systems. The explosion of offerings in various vendors’ App Galleries is one example of this trend. One of the biggest resulting challenges will be to enable a provider to quickly find what they need for a specific patient.
- Value-based care, particularly Medicare Advantage (MA) and similar programs
At its current rate of growth, MA is on track to reach 69 percent of the Medicare population by the end of 2030. CMS has set a goal to have 80% (or more) of Medicare patients on managed care plans by 2030. The aging population, including people with chronic conditions who are living longer, requires a new set of tools to identify those patients and to effectively manage, evaluate, assess, and treat their conditions. MA uses risk-adjusted reimbursement. The industry’s current focus appears to be on identifying those conditions that provide for higher reimbursement. The challenge will be how to better manage chronic conditions to reduce costs––not just to account for it. Healthcare information systems can no longer be merely accounting and billing platforms, they must be clinical management platforms that support all individuals who provide care.
- Telehealth, social determinants of health (SDOH) and communities of care
In addition to technology, reimbursement, and regulatory changes, there are societal factors influencing the development of systems to support healthcare delivery.
The COVID-19 pandemic has accelerated the adoption of telehealth as a primary point of contact for patients. A new focus on SDOH shows promise for engaging community resources to help patients who may not otherwise be able to access needed services. With patients and their families or other caregivers having access to their own information, and the framework being established for the sharing of that information across all points of contact, it will enable a “community of care” to be established for each patient.
This community of care scenario will mean that all participants in each patient’s personal community of care must have access to information at the point of need. That point of need can be at the time of registration or screening, either in-person or through the much touted “digital front door,” at the time of patient/clinician encounter (virtual or otherwise), during a home care visit, during pre-visit planning by a care team, during a visit with a school nurse, and all other settings where care is delivered or managed. The 21st Century Cures Act, TEFCA, and FHIR provide the basic building blocks for sharing patient medical information. Combined with new innovations for cloud-based technology deployment, enterprises now have both the motivation and the tools to transition from transaction-based reimbursement to true value-based care.
Patient-Centric, Community-Based Care
Holy Name Medical Center in Teaneck, New Jersey, decided to put all of this together and build a community health record for each patient. The record ties together every interaction with a patient, with any healthcare provider or other point of contact, into a single patient medical record. Implementing this new patient-centric, community-based system required Holy Name to build a new type of clinical management platform––with all the factors mentioned earlier. Incredibly, they managed to accomplish this during the pandemic. They have now been live on the new system for a full year––deploying first in their emergency department––and are now building it out to the rest of the health system. We believe this new way of using the latest technologies, linking patients with all members of the community involved in their care, is a glimpse into the future of healthcare delivery.