Electronic Health Reporter

Guest post by Michael Simpson is the CEO of Caradigm.

It’s been five years since the HITECH Act was enacted as part of ARRA, and while there’s still a lot of debate about the technical details, rules and timelines involved with electronic health record (EHR) adoption and meaningful use, it’s clear that the focus on EHRs – and incenting hospitals and professionals to use EHRs in a meaningful way – represents a critical, foundational step in transforming health care in this country.

After all, meaningful use targets the right goals – goals that every hospital, health system and healthcare professional supports, including improved quality, safety and efficiency of care; reduced disparities; more engaged patients and families as core members of the care team; improved care coordination and population health; and more secure patient health information.

More important, the stages of meaningful use drive a set of progressively more advanced capabilities that are fundamental to achieving those goals. Digitizing data was the first critical step, and the good news is that according to a recent HHS press release, about 60 percent of all hospitals have adopted an advanced EHR, leaving the paper world behind. The next steps are sharing that data – securely – among providers and patients, reporting on quality to understand and improve it, using clinical decision support at the point of care, and many other capabilities critical to transforming care and outcomes. If providers and professionals meet meaningful use requirements, we should see more transparency, greater efficiency, reduced waste and more healthy people in our communities over time.

Stage 2 Challenges

It’s a long and challenging journey, and while hospitals and health systems are making good progress against Stage 1 requirements, very few are prepared for Stage 2. In fact, according to survey data from the American Hospital Association, fewer than 6 percent of hospitals have met the criteria for Stage 2, and only 10 percent have met the requirement for patients to be able to view, download and transmit their health information online.

Why are providers getting stuck as they try to move to Stage 2? Because as the requirements become more demanding – e.g., using clinical decision support, generating patient lists, protecting patient health information, engaging patients – these organizations need a new set of technology capabilities to meet those requirements.  These capabilities leverage and extend the functionality and benefits of the EHR.

Moreover, to reach the ultimate goals targeted by Meaningful Use — improved quality, efficiency, outcomes and population health — providers will need to aim even higher than meeting the requirements of meaningful use stages, strategically using data from EHRs and myriad other systems across the care continuum to enable a new level of capabilities.

For example:

• More must be done to engage patients than simply letting them view, download and transmit their health summaries. Providers must be able to share care plans with patients as part of the care team.
• Basic tracking and reporting on quality isn’t sufficient. Providers must be able to identify gaps in care and then take the necessary steps to make positive change.
• Providers need to do more than merely sharing care summaries across the continuum. They must develop personalized, evidence-based care plans and share across the care team.
• And with providers sharing and providing access to sensitive data, they must be able to manage patient privacy and data security.

Although it’s still early, there is growing consensus about the capabilities providers need to achieve Stage 2 goals — as well as broader goals for improved quality, outcomes and population health. In the end, providers need four fundamental capabilities that extend the power of EHRs: data control, analytics, care management and patient engagement.

Stage 2 requires providers to use clinical decision support to improve performance on high-priority health conditions. To deliver on this capability, according to the CMS website, CMS is asking providers to implement “new HIT functionality that builds on the foundation of an electronic health record” to help clinicians make the right interventions at the right time. For effective clinical decision support, doctors and nurses need access to a wide range of clinical, operational and financial data that resides in systems across the broader healthcare community — because the vast majority of patient activity happens outside of the hospital or clinic. They need data from billing systems, payers, pharmacy systems, labs and health information exchanges, and they need it in near real time.

Once the clinical, operational and financial data is combined, providers can turn it into a strategic asset that drives greater insight, not just about individual patients but about populations and performance as well. Clinicians gain a longitudinal patient record for better insight at the point of care, and professionals throughout the hospital gain the ability to perform real-time and predictive analytics – not just retrospective reporting. For example, with risk stratification, organizations can classify patients by level of health risk to help optimize care and resource utilization. Using predictive algorithms, they can predict patients at highest risk of readmission to the hospital and take measures to help prevent the event from occurring.

A key requirement is care coordination. Providers need to drive care coordination and care management through intelligent, personalized and evidence-based plans of care based on near real-time data and insight. This moves us far beyond the sharing of care summaries, to actually coordinating care for patients according to a shared plan as they transition from hospital to clinic to home.

And the last mile – but vital to improving care and outcomes – is patient engagement, which means fully engaging patients and their families as core members of the care team. While an EHR can typically only support some basic patient-provider communication (secure messaging, appointment scheduling and viewing a health summary), to engage patients fully as core members of the care team, patients will need access to their evidence-based care plans, which are built with data-driven analytics solutions spanning beyond the data and capabilities of the EHR.

These four broad capabilities – data control, healthcare analytics, care management and patient engagement – are vital to improving care and outcomes associated with Meaningful Use Stage 2, and build on and extend the value of the electronic health record, the fundamental first step of transforming care.