There is growing concern that electronic health records (EHRs) will not meet physicians’ needs in a value-based care environment, especially as the federal government moves forward with Medicare payment reform, promoting safer, more effective care while controlling costs.
Commercial insurers likewise are pursuing value-based models as a way to more effectively promote high-quality care. They seek more efficient and affordable care by adopting models similar to accountable care organizations and by using core quality measures in their programs.
“What I’m hearing from clinicians about what they need from EHRs and value-based care is pretty simple: They want anything that will improve” their patients’ health, says Kate Goodrich, MD, MHS, director of the Center for Clinical Standards and Quality and chief medical officer for the Centers for Medicare & Medicaid Services (CMS). “If that means digitized health data, then that health data needs to be accessible no matter where or when it is needed. If that means quality measures, then those need to be applicable, outcome-based, and with reliable feedback that shows the clinician how to improve.
Health IT, including EHRs, is instrumental in making value-based care work. But simply having an EHR in place won’t be enough to support value-based care, experts say. EHRs must be fine-tuned, with all the available functions, integration points and automation needed to deliver the right information at the right time enabled. Moreover, experts say physicians should ensure that they not only optimize their software but have successfully integrated it into their practice workflow.
“Moving [to value-based care] is a difficult transition for most small practices to make, and even for some large organizations to make as well. It’s complicated, but EHRs allow us to deal with complicated data in a more streamlined way,” says Stephen Beck, MD, FACP, FHIMSS, an internist and former chief medical information officer at Cincinnati-based Mercy Health, who is now a consultant with BecTech LLC.
To better optimize EHRs for value-based care, physicians first need to verify that their existing system offers (or can soon have via an upgrade) the reporting capabilities needed to meet the requirements of the Medicare Access and CHIP Reauthorization Act (MACRA), says Mark G. Weiner, MD, FACP, FACMI, a primary care physician at Temple General Internal Medicine Associates in Philadelphia. But he also recommends
investing in EHRs that have more advanced reporting functions.
“Investments need to be made in the type of reporting that not only meets the need of the MACRA quality reporting requirements, but also the kind of reporting that can help you anticipate and address the specific needs among patients who are failing and perhaps even looking out for people [with chronic conditions] who have been well controlled but who maybe turning the corner in a bad way,” he says.
According to Richard Loomis, MD, vice chair of the Healthcare Information and Management Systems Society (HIMSS) Electronic Health Record Association, EHRs that are 2015-certified will meet the quality reporting requirements.
Loomis, who is also chief medical officer and vice president of informatics for EHR vendor PracticeFusion, says this certification criteria will be important for participating in the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APM) payment tracks that are part of MACRA.
EHRs need analytic capabilities
Health IT experts suggest that physicians ask whether their EHR has the analytics capabilities to allow them and their staff to study patient data to gain insights, such as unique circumstances that prevent certain patients from achieving their desired health outcomes.
Weiner explains that such capabilities help physicians see trends among patients who may need different or additional treatments or care approaches to meet outcomes specified under value-based care models.
In addition, Weiner says, physicians should determine whether their EHR enables them to identify patients who, based on data such as missed appointments or troublesome biometric measures, might be facing a predictable medical issue.