The Coming Electronic Medical Records "ARMS RACE" to Support Value-Based Care

With the advent of value-based care, the EHRs aren't enough for value-based care blog is a very succinct analysis of the need for radical change in the electronic health record.

The author states that the EHR must be capable of importing longitudinal lifetime data from any patient to assess the value of any given treatment or evaluation.

This means that the provider must process all the past medical history and up-to-date treatment and evaluation protocols in determining how to proceed.  The typical provider has neither the time nor energy to accomplish this goal without lots of help.

The new Electronic Health Record will have to:

1. Attain a level of interoperability through out the entire medical universe.  A good first step is a national database.
2. Both during and at the end of an evaluation, the provider must receive artificially intelligent notifications as what to do next.  The opposite is also true- What not to do!
3. The EHR will have to link automatically to multiple treatment guidelines and suggestions made by various societies.
4. The CPOE will have to reflect both cost and effectiveness of any orders or treatment plans.

This obviously is not a simple task with multiple layers of complexity.  What is most likely to happen?

When the new payment guidelines are released:

1. The EHR developers and the providers will have to program the EHR to notify the provider of what documentation needs to be filled out in order to get paid.  This will have to be a dynamic function as the rules will be constantly changing.
2. The EHR at the end or during each encounter will have to present the providers with a checklist of documentation required.
3. It will be a race to accomplish these goals, so that payments will not be interrupted.

Will this provide better medical are in the long run?  Let us hope so.  If the goal of value based payments is to reduce costs, it will probably be successful because of the new documentation requirements.  However, the technology people will respond as they have in the past to deliver a product that supports the providers.  This will also lead to massive changes in practice management and billing protocols.

Cost of a Click

In the article The Hidden Cost of a Click, the author states, “A bad user interface can turn an EMR/HER into a minefield of medical errors and inefficiency.”

 

At the present time, the number of clicks necessary to fill out a chart is endlessly time consuming and non-productive.  The cost per click is now being calculated and quantified.  The work flow is slowed down and there is a real-not imagined- price to pay.

One solution is to create an auto-flow sequence that is tunable by site or provider and that comfortably guides the clinician from one area of the chart to another in a logical-customary- sequence.  If an out of sequence entry is desired, this should be easily accomplished.  A system with automatic guidance will eliminate the need to figure out where one should go next, especially if one is interrupted.  When it is acknowledged that one area is complete, it then moves to the next area when documentation is continued or resumed.  Once the area is completed, the list shrinks.  Your favorite click might be auto-sequenced.

An example sequence could be...

• Vital signs
• Triage sheet
•  Past medical history
•  Nursing notes
• History and PE in logical order
• Medical decision making
• CPOE
• Lab and x-ray results
• Clinical course
• Final diagnosis
• Disposition
• e-Prescribing
• Patient education
• Follow-up
• Review nursing notes
• Sign the chart

Navigation would be significantly simplified.  The provider can always go to any area directly and in any order.  Nursing notes might be reviewed, if easily accessible.  Training would be simplified and hopefully stress-reduced.