In plastic surgery, we live by the maxim that to correct a problem in one area is to create (or expose) a problem in another area. That is what I see happening with the transition to EHRs. The use of EHRs has rapidly increased and expanded over the past five years. The HITECH Act and the onset of meaningful use have provided significant incentives to assist practices and providers to implement EHRs in their practices.
Many initiatives to improve care delivery and patient handoffs have also expanded the emphasis on EHRs, leading to expanded use in both emergency departments as well as outpatient settings. According to the National Center for Health Statistics, the use of EHRs in the emergency department nearly doubled from 46 percent to 84 percent in the five years preceding 2011. The growth on the outpatient side was even more significant with a change of 29 percent in 2006 to 73 percent in 2011.
EHRs allow us to leverage the power of computers to provide a better quality of service to the patients who rely on us for their care. They provide great benefits to care delivery, including automated evaluation of drug interactions, preventative healthcare suggestions, persistent patient problem lists, and electronic prescribing, among other components.
While there has been fantastic progress made toward the goal of successfully implementing EHRs at all levels of the U.S. healthcare system, we still have work to do to ensure the process works smoothly for patients and providers.
Problems are arising as they are being solved.
Providers have expressed concerns about needing to refine the EHR process to enhance productivity, not decrease it, as well concerns about perceived reduction in patient satisfaction and attentiveness to patients.
Another issue is the very real problem with fraudulent documentation. The EHR was created to assist providers and hospitals for properly documenting the care that is delivered in support of appropriate, higher level coding. However, a small but significant level of falsification of records is occurring, facilitated by the utility of the EHR, that is driving up healthcare costs. To combat this, insurance carriers and CMS are employing increasingly sophisticated tools to detect fraud in the EHR, and going after providers and facilities to recover fraudulent reimbursement, among other penalties.
I still believe in the promise of the EHR. I’m confident that the EHR will fulfill its potential to become one of the more valuable tools that we have in modern medicine to improve the care we give to patients.
How can we combat some of these problems that are arising due to EHRs? Here’s my prescription:
• Provide more and continuous training resources for providers in the use and utility of EHRs.
• Clearly define and explain how EHRs can contribute to and result in fraudulent and nefarious practices. It is also the responsibility of the provider to understand this issue, as ignorance of the laws and regulations is no defense.
• Provide more tools to make it easier for providers to focus on patient care, and not the process of charting and ordering in EHRs. Examples include biometric log on to systems and enterprise level medical dictation to cut down on the time drain that EHRs represent in the current deployment.
• Be patient. A transition is a change from one paradigm to a new one. It takes time, money and resources to change something as significant as the way in which we document the care that we provide.
I discover additional utility in the two EHRs that I use daily by being inquisitive, and working with IT and the representatives of the software providers. It can seems like a daunting task due to the time pressures under which we all operate in our respective clinical environments, however, the benefits will be far worth it in the long run. With the proper training, and support, we can reach our potential and get the focus back where it belongs — on patient care.