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Prepare your EHR now for value-based care


As healthcare shifts from fee-for-service to a model based on quality care, physicians need to make sure their computer systems can keep pace.

The electronic health record (EHR) systems implemented in physician practices across the country were first built for a healthcare system based on fee-for-service payments.

Now the industry is shifting to value-based care, where payments will be tied to patients’ outcomes. This begs the inevitable question: Are current EHRs up for the change?

The answer depends on who’s answering. Health IT experts offer different perspectives on how prepared computer systems are to handle this shift. Some said EHRs are already capable of working well in a value-based care model, while others disagreed, saying much more work needs to be done.

Regardless of whether there’s a little or a lot of work ahead, several health IT experts who spoke to Medical Economics agreed that physicians can take steps now to prepare their EHRs for the expected transition in how reimbursements are handled.

“It will take some workflow adjustments within the clinic, but the preparation you do now will make it easier as you move forward,” said consultant Vanessa Bisceglie, MBA, CEO and president of CareVitality Inc., which provides health IT advisory services.

Rick Shepardson, director of optimization solutions at Nordic Consulting Partners, said physicians can start preparing by first optimizing their existing EHRs. He advised physicians to use the functions that come with their existing EHR and understand how all the features can help them streamline administrative and clinical services while also collecting all the data that will need to be recorded and analyzed under value-based reimbursement models. He acknowledged that it’s a simple step, but one that many physicians have yet to take, as many currently don’t use all the functions available to them.

Next, physicians need to consider how they’re going to participate in this emerging healthcare market, Bisceglie said. She said physicians need to decide whether they’ll participate as a primary care (or patient centered) medical home, known as PCMH, as part of an accountable care organization (ACO) or under another such entity. She said that decision significantly shapes what data needs to be collected and shared, under the federal government’s Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

“Doctors first have to understand how they’re going to move forward, and then they need to understand what measures they’re going to be reporting on; they can pick which measures. Then they have to look at their system and ask whether they have to be customize it or optimized,” she said.

Bisceglie said such reflection can help physicians determine which information fields, what data and which computer shortcuts based on how they practice medicine they will need and find most useful under the coming reimbursement model.

Next: How to deal with vendors


Be proactive with vendors

Health IT experts noted that EHR vendors are also considering such questions so they can update their systems. But Bisceglie cautioned against waiting for updates to be announced; instead, she advised physicians to work with their EHR vendors to understand the changes that are happening, when the changes are going to be completed and the timeline involved.

“If the vendor isn’t going to help you move forward, it should be an alert, Bisceglie said. “It’s very important for practices to understand where their vendors are at, how they’re modifying their systems, and if they’re not, [physicians] should be looking for another system so they’re not left holding the bag.”

At the same time, Bisceglie also advised primary care physicians to examine the relationships they have with specialists and medical facilities because sharing data will become increasingly critical with value-based care.

“Doctors will have to think about their partners, and whether they can get information and whether they can seamlessly connect or have interoperability with those partners,” she said, noting that physicians must ensure that data being shared with and from their EHRs is transmitted securely and compliant with all privacy regulations. “Doctors will have to make sure all the notes and data are coming back to them because they’ll be responsible for all of that.”


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