Electronic Health Reporter

Guest post by John Squire, president and COO, Amazing Charts.

As developers of electronic health record (EHR) software, my company gets into a lot of conversations with providers about their expectations for the future. This information helps us make decisions about what to build next. Here are three trends we’re hearing from our customers right now:

Low-tech beats high-tech in telemedicine

Unlike the way it was imagined decades ago by science fiction writers, telemedicine does not necessarily mean holographic images or live video conferencing with a physician half a continent away. Patients would rather receive “low tech” remote care from their primary care physician who has a full picture of their health status.

This form of telemedicine happens whenever an EHR system adds to a patient’s clinical chart the messages, pictures, or videos sent securely via smartphone. It happens whenever a smartphone connects to a remote health monitoring device for collection of real-time data such as blood pressure, oxygen levels, and heart rate.

The new rules allowing reimbursement of telemedicine and other non-face-to-face services will encourage physicians to bill for these remote care activities. Medicare’s recently expanded set of billing codes for Chronic Care Management (CCM) is a good example of how the future of value-based care goes beyond the office visit to keep patients out of hospitals and emergency rooms. The ability to securely and rapidly receive and answer a patient’s questions via text, and then capture those activities in the patient’s permanent clinical record is a critical step in that direction.

Primary care providers are trying new types of practices

Primary care physicians are frustrated with the hassle and expense of dealing with insurance companies. The new Medicare fee-for-value quality payment program is creating uncertainty about future reimbursement levels and requires additional reporting. Also, there is an acute level of burnout with “corporate medicine,” which has providers booked for dozens of daily appointments, only to spend less than 15 minutes with each patient.

In order to remain independent, a small but growing group of primary care practitioners are becoming more financially creative and experimenting with new models of practice. One example is direct care, in which a financial relationship is established directly between patient and provider, cutting out insurance altogether. This model includes concierge and direct primary care (DPC), where patients become “members” of a practice and pay a fixed monthly fee for unlimited primary care – similar to a gym membership, but for healthcare. Another example of direct care is the cash-only practice that sees walk-in patients for urgent care.

EHR interoperability will catch FHIR

Physicians and their patients are frustrated with the lack of interoperability in health IT. The concept of having a patient’s medical records accessible to any authorized provider at any time is still a rare occurrence. When a patient switches primary care physicians, the first office typically prints out and faxes their medical records to the second office, which introduces the possibility of errors, HIPAA violations, and others.

We are making some progress. The federal government is promoting a two new standards: a better Consolidated Clinical Document Architecture (CCDA) format for the data itself and a new standard for exchanging systems to talk to each other called Fast Healthcare Interoperability Resources (FHIR). FHIR is a richer way to exchange health information without the rigid workflow of traditional standards. Providers tell us they are excited to have a wider choice of technology solutions that can be used alongside the EHR to improve patient outcomes.

The universally accessible health record remains a dream of the future, although researchers at MIT recently published a novel proposal for managing medical records. MedRec is a decentralized system that uses Ethereum blockchain — the same technology that’s behind Bitcoin — to manage authentication, confidentiality, accountability, and data sharing. The content of the patient’s medical record will not be stored on the blockchain and their data will be kept securely in providers’ existing data storage infrastructure. Although early, if MedRec becomes a reality, it will revolutionize access to medical information for both patients and providers.