Saturday, August 15, 2015


It’s no secret that many physicians are unhappy with their electronic health record (EHR) systems, thanks in large part to cumbersome processes and limited features that get in the way of patient care. Now a panel of experts has called for EHR overhaul, outlining the eight top challenges and solutions for improving EHR usability for physicians and their patients.
Much of this post is taken from an AMA symposium on the use of EHR in July 2015.  All of you who are already using EHR know about the strengths and weaknesses, and even outright failures of electronic health records.

Electronic Health Records, AMA Townhall, Atlanta Georgia

8 top challenges and solutions for making EHRs usable
1. Enhance physicians’ ability to provide high-quality patient care.
2. Support team-based care. 
3. Promote care coordination.  
4. Offer product modularity and configurability. 
5. Reduce cognitive work load
6. Promote interoperability and data exchange
7. Facilitate digital patient engagement.  
8. Expedite user input into product design and post-implementation feedback. 
The The Affordable Care Act posits affordable care, improved access, formation of accountable care organizations, patient centered care, medical homes and more.
The Patient Protection and Affordable Care Act is made up of the Affordable Health Care for America Actthe Patient Protection Act, and the health care related sections of the the Health Care and Education Reconciliation Act and the Student Aid and Fiscal Responsibility Act. It also includes amendments to other laws like the Food, Drug and Cosmetics Act and the Health and Public Services Act. 
Despite the lofty goal of providing excellent care, The Affordable Care Act and HHS the incentivization program has had the diametrically opposite effect on unifying clinical practice.
The addition of EHR does nothing to really enhance communications between providers. The paper silo has become a digital silo.  Physicians and patients assume that the EMR connects physicians when most physicians do not have time to read and entire EHR.  Physicians used to communicate directly with each other, but in many cases they no longer do so, assuming the referral physician and the consultant have spoken.
Meaningful use  III challenges physicians and patients to use portals for a certain percentage of patients. Many medicare patients already chose between necessity of life (food, shelter, medications) and do not have internet access. Yes, there still are many that do not "live the dream".
The data elements will continue to increase, with wearables, such as fitbits, blood pressure and/or blood sugar monitors, and remote monitoring.  Will these too be incorporated, seaminglessly into the EHR ?  
It is far better to anticipate these changes than to wait for it to happen.
CMS needs to realign it's mission to patient care, and provider efficiency. CMS Bureaucratic bloat has not so silently increased. Much of it's resources are to distribute the social program for medical care and to prevent fraud.

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