Wide deployment of electronic health records systems and their use by clinicians doesn’t mean that physician acceptance is anything but grudging.
Doctors’ disillusionment with records systems and how they affect care delivery is high. The transition to value-based care and health policy changes expected out of Washington represent a golden opportunity to address clinicians’ usability concerns with records systems.
Work needs to begin now to rethink how clinicians interact with, and gain value, from records systems, according to a panel of experts speaking at an event sponsored by McKesson at this week’s HIMSS17 Conference and Exhibition in Orlando.
Like other information systems used by providers, EHRs were designed to facilitate charge capture and claim substantiation. With growing emphases on value and quality, EHRs would benefit from a refresh, and physicians need to lead the way in determining how to make records systems fit their needs.
“To redesign these systems, we need to go from the bottom up, not the top down,” said James Barr, MD, vice president of clinical intelligence at Atlantic Health System. “To impact change, we need broader strokes of the value-based payment model. This is expensive to do, when we have to develop the data skills. To hope to see a return on that investment is very challenging.”
New reimbursement approaches will reward quality and lessen the need for fee-for-service capabilities in healthcare IT systems, said Zak Ramadan-Jradi, MD, executive director and vice president of accountable care for MultiCare Connected Care.
Information systems now are aimed at helping providers “systems pay for their bills,” Ramadan-Jradi asserted. “To truly move to accountable care is really going to require a lot of investment. I see organizations making tweaks to their IT programs, but to move into true accountable care will take a wave of new investment.
“We’re still at that early stage of accountable care, where we have two tracks going (fee-for-service and value-based care), which is really quite expensive,” he added. “As a nation, we really have to take that leap of faith and move into accountable care.”
But making the commitment to move to a pure accountable care approach is difficult because it’s an entirely different approach, said Lili Brillstein, director of marketplace innovations for Horizon Blue Cross Blue Shield of New Jersey.
“We’re just at the beginning of the revolution,” she said. “At Horizon, the work we’re doing in New Jersey puts us ahead of the pack, and we’re committed to making these changes, but it doesn’t mean we have it completely right. We kind of just have to do it. These programs are not going to be right or perfect at the beginning. You just have to stay open to change.”
Physicians are technology weary at this point, and need to believe that new technology approaches will help them practice medicine, not further burden them with duties that they perceive to be data entry tasks, Barr added.
“We have this issue of burnout, and it reflects the amount of squeezing of physicians for how many things they have to comply with,” he said. “They are starting to question if they’ve made the right decision to practice medicine. If we can use our information systems and make them more efficient and be able to look patients in the eyes again, they’re more likely to say, ‘Wow, I really like what I am doing.’
“And if I am able to become a better doctor, then I think the tipping point (for willingly using IT) is getting closer,” he added.
Ramadan-Jradi said it’s imperative that physicians also believe that the data contained in systems is trustworthy, and that they believe the systems are designed to support them in their care delivery.
“It’s a gliding path,” he said. “First of all is the integrity of the data; that’s crucial because, in the end, physicians are scientists,” he said. “Then, it’s being able to bring information to physicians when they need it, when they can use it in the workflow.”
“The key is actionable data,” Barr added. “That is, it has to have meaning. Physicians need to see that the resulting care model is making a difference. When we do population health management right now, why don’t we know what the patient’s needs are right now? I should have information that’s actionable like that to enable me to work smarter, not just harder.”
The right information, combined with analytics that accurately measure different outcomes, can sway physician willingness to embrace IT, Barr says. “Physicians, by personality, tend to be competitive people. It’s a performance culture that fits right in to the language of performance and accountability.
“But before that point, we really have to re-establish the culture of healthcare in this country—whatever we are going to do, we need to care better,” Barr added. “Care is still a verb. With information systems, we have to say we’re going to help you care better for patients, then help patients care better for themselves, then help us as a country care for people. We really need a culture change to take us down the right path.”
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