EHRs are a divisive topic. Some clinicians hate them and feel like they are causing burnout. Patients may feel like technology take away from the patient-provider relationship. Advocates for EHR believe they are a necessary step to pushing healthcare in the 21st century and improve care.
Regardless of people’s opinions, EHRs are not really optional. CMS’ Meaningful Use program requires physicians to use certified technology or get penalized with reduced Medicare reimbursement. The belief is that EHRs will greatly improve interoperability, care coordination, patient safety, privacy, lower healthcare costs, and enhance clinician efficiency.
In reality, EHRs are not black and white. They’ve have had some successes, but they have missed the mark in other areas. EHRs have been good for the business of healthcare, but they have struggled to improve the delivery of healthcare so far. What does this mean? Let’s break it down:
EHRs: Business of Healthcare
The business of healthcare is focused on billing, coding, and financial aspects of healthcare. Organizations need to make money to pay their employees and expenses, so it is important to work on the business of healthcare so that they can fund it and keep the organization open. For this business aspect of healthcare, clinicians and coding professionals work together to assign appropriate codes to different diagnoses and services the clinician provided. Then these codes are used to bill Medicare and Medicaid, private insurance companies (or the patient, if they pay out of pocket). The healthcare organizations then get reimbursed for the work they did.
EHRs are good for addressing the business side of healthcare. They keep all the patient information in a single, digitized format. Within the system, employees are able to code everything, and then use that to create bills to send to the payers.
Delivery of Healthcare
The delivery of healthcare is all the work related to providing care for patients. This can include scheduling appointments, reviewing patient notes, responding to patient or other clinician emails, completing patient notes, and providing patient care. This is important because the goal of healthcare is to provide care for patients.
EHRs are not practical for the current delivery of healthcare. Medicine has evolved from clinicians working individually to clinicians working as a care team. The care team is advantageous because it allows for a variety of clinicians with unique, specialized skills to share ideas to provide the best care they can for patients. However, EHRs were not designed for collaborative care teams. They are siloed, and not conducive to teamwork, meaning clinicians need to adjust their work to fit the health record system.
In addition to collaboration issues, EHRs have seemingly contributed to clinician workloads. EHRs were meant to digitize paper records, and they did. With these digital records has come significantly longer patient notes, much of which are copied and pasted from previous notes, even if all the information is not relevant to the visit. This can make it more difficult for clinicians to find the important notes. While this may be due to regulations, the increase in regulations has coincided with EHRs, and EHRs have made it easier to simply copy previous notes and enter them into the chart.
Getting rid of EHRs is not a viable solution. EHRs have done some good for healthcare, with the potential to do better as the tech becomes better. Also, these systems are extremely expensive, and healthcare organizations do not want to stop using something they just spent so much money on. So, what can healthcare do to improve how EHRs work with the delivery of care? Use apps and technologies that integrate into the EHR that can improve care delivery. The EHR does not need to do everything itself. If it’s the jack of all trades, it’s the master of none. Using clinician-designed applications can improve care delivery while allowing the EHR to continue doing what it does well with the business of healthcare.