EHR Adoption Alone Does Not Guarantee Quality Care

Under the Health Information Technology for Economic and Clinical Health Act of 2009, healthcare providers are now offered incentives to use electronic health records (EHRs).

A recent analysis from the Centers for Disease Control and Prevention (CDC) found that by 2011, 55 percent of physicians reported they had adopted EHRs, indicating that EHR adoption is finally on the rise. Moreover, three in four adopters said their system met the Act’s criteria for meaningful use.

Healthcare providers deserve recognition for adopting EHR systems. Their journey to date has not been easy, with challenges ranging from unexpected expenses to the logistics of incorporating technology smoothly into their interactions with patients.

Adoption of an EHR in and of itself does not improve care. Having electronic access to data is just the first step. Quality is only improved when providers interpret data to connect the dots between diagnoses and treatment options.

Academic literature on the benefits of EHR adoption varies dramatically, leaving providers without a clear path forward during this important transition period. Avalere Health has identified six steps providers can take as they leverage EHR utilization to improve quality of care:

1.) Improving pre-visit planning – Review EHR data to identify all care needs for a given patient. For example, if the patient visit is for an acute reason, such as a sore throat, and the patient has diabetes, review the data to see if it is time to order lab tests or conduct a foot exam.

2.) Enhancing care at the point of care – Use data in the EHR to identify all of a patient’s healthcare needs, including acute care, preventive services, and treatment of chronic conditions such as diabetes.

3.) Identifying specific patient populations – Categorize sub-populations of patients within a practice. This will help quickly identify patients who can benefit from procedures and medications found in new or revised guidelines. For example, the American Hospital Association and American College of Cardiology Foundation recently updated the guidelines for managing patients with unstable angina or non-ST-elevation MI to include Ticagrelor. Optimal EHR usage would put this update into practice by adding Ticagrelor as an option to prescribe to patients. The ability to do population management is arguably one of the biggest advantages of implementing an EHR.It is also an activity that will be new to many practices given that it was virtually impossible to do in a paper-based system.

4.) Participating in national, regional, and local quality initiatives – Physicians should report their data as a means of participating in as many pay-for-reporting and pay-for-quality initiatives as they can. In addition, physicians should participate in quality of care registries to address opportunities to improve care.

5.) Comparing processes of care and outcomes with other doctors – This is a great opportunity to share best practices and learn about medical innovations. Begin by comparing data within your practice and explore opportunities to provide data to local, regional or national organizations involved in evidence-based benchmarking.

6.) Involving patients in their own care – EHR data can be used to facilitate shared decision- making. By presenting such data, along with educational materials, patients will be more engaged in making treatment decisions and better manage their own care.

A wide range of stakeholders would benefit from improved and more focused use of data housed in EHRs. At a minimum, providers may be encouraged to adhere to new guideline recommendations sooner and may potentially receive higher reimbursements for ensuring a healthier patient population.  Public and private payers would see costs decline as a result of better care coordination and management. Finally, patients would receive more focused care, enhancing compliance and improving outcomes.

Challenges remain, including the need for EHRs to evolve or new tools to be developed to support real-time analysis of data in order to continually improve care. Regardless, there is no questioning that care can be improved today by using available data in the EHR to better inform treatment decisions.

Avalere Health’s Debbie Lucas, Kristi Mitchell, and Barry Dalin focus on translating evidence-based guidelines into practice and using health information technology to facilitate improvements in care.