By Phil Giarth, Director of Product
Published by: Healthcare Business & Technology
Data transparency between healthcare organizations is requiring hospitals to optimize data integration, aggregation, reporting and analytics. In this guest post, Phil Giarth, director of product at a healthcare technology company, explains how a leading-edge browser extension to an electronic health records system can enhance data management, reporting, population health management and care coordination.
One of the most meaningful proposals from the U.S. Department of Health and Human Services (HHS) is a new rule to support seamless and secure access, exchange and use of electronic health information (EHI). The impact of this new rule upon payors, providers and patients will resonate in terms of increased innovation, competition and transparency. Patients and their healthcare providers can look forward to secure access to health information, as well as new tools, allowing for more choices in care and treatment.
What’s more, it also calls on the healthcare industry to adopt standardized application programming interfaces (APIs), which will allow individuals to securely and easily access structured EHI using smartphone applications. The proposed rule places a strong focus on a patient’s ability to access their health information through a provision requiring that patients can electronically access all their EHI at no cost.
Paradigm shift for health care
This legislative push would require data transparency between health organizations through a central and secure exchange of EHI. For payors, this includes anything from claims to clinical data, including labs, pharmacy, immunizations and vitals. For hospital systems, this includes clinical notes and admits, discharges and transfer (ADT) files.
All this information is pivotal for value-based care to deliver the most real-time and actionable information at the point of care rather than information from claims filed 60 to 90 days after the care was provided.
Hospital executives and leadership teams that are currently participating in value-based contracts already understand the importance of investing in leading-edge electronic health record (EHR) technologies to optimize data integration, aggregation, reporting and analytics. This proposed rule should prompt other healthcare organizations and additional participants to follow suit. Clearly, this new reimbursement landscape focuses on quality of care rather than the volume of services, but many feel challenged about where to begin building out their capabilities. The goal is to proceed in a way that optimizes the opportunity to better serve patients, improve outcomes and effectively make the shift to value-based care.
When the bottom-line hinges on quality and value incentives, it’s wise to invest in a leading-edge browser extension to the EHR – one that turns data into insights, improves care and lowers costs – to enhance data management, reporting, population health management and care coordination.
Why EHR matters
EHRs are used to manage patient records, but they’re only as effective as the information that’s entered. Typically, this means they represent a single source of patient information, usually from the primary care physician (PCP). Once the patient seeks care from another provider, ER or specialists, the benefits of the EHR begin to break down. Data generated by multiple providers or specialists aren’t likely to reach the PCP.
Another factor impacting breakdown is these providers, hospitals and specialists typically are treating only the current condition presented at the point of care rather than all the issues confronting the whole patient. EHRs fail to contain a full picture of the patient or have capabilities to share information, especially those residing in hospitals that use coding to drive the best diagnoses-related group (DRG) and serve cost containment initiatives.
Direct integration to/from EHRs allows this data to be seamlessly available at the provider’s fingertips. The problem is that the typical EHR has yet to master how to economize on full population health analytics. For example, with a post discharge, have all the federal rating gaps been completed? Are there any acute conditions post discharge that need to be updated? Do medications need to be reconciled? Was the patient discharged without waiting for a claims feed, which is not a real-time census feed?
To maximize the value-based care opportunity, these questions must be integrated into systems that are also interoperable with all parties freely sharing patient data in a two-way street. The absence of interoperability creates a burden for hospital systems and undermines payor efforts to achieve high quality care and more appropriate utilization. It also impacts reimbursement and profits – money and resources that are better used to improve diagnostic and treatment capabilities or attract new patients.
When more information is shared historically, it allows payors to manage the whole patient experience. For example, when a patient moves from one payor to another, the burden falls on the new network of providers to perform tests, many of which may be unnecessary. But when that existing information is shared in one centralized database or system that everyone can access, there are measurable time savings, reduced provider burdens and higher quality care that translates into better value for every stakeholder.
Ultimate browser extension for EHRs
Fortunately, solutions designed for value-based care are emerging based upon the concept that EHR is one of many tools necessary to help healthcare leaders and providers better understand and manage the cost and quality of care
Data shows that for non-elective/non-orthopedic hospitalizations, a best-in-class browser extension can reduce up to one-third of readmission and almost 40% for hospital-acquired conditions, such as pneumonia and UTIs.
Creating these feeds of historical information must be real-time and centralized to improve capabilities for receiving faster authorization across competing payor organizations. In its absence, redundancy and provider resistance occur.
Consider the example of colorectal cancer screenings. The National Committee for Quality Assurance’s (NCQA) rating system requires one screening every 10 years, depending on the service provided. If a patient moves from one payor to the next, the burden of proof for this service falls on the provider. When EHRs have the added capability of making predictive recommendations to ease this burden, it’s possible to enable and optimize value-based care – and reap the incentives.
Here’s another good example: CMS Star Ratings measure HbA1cs under control <8%. If a provider bills the 83036, the provider will have to submit supplemental data to provide the actual lab value. If a system is sophisticated, it should recommend billing CPTII 3045F, which indicates the lab value and service provided, and reduces the supplemental data needed.
The future of EHRs in value-based care comes down to combining the contracted elements of the arrangement between the entity and the risk-bearing organization (typically the payor) that show the economics of taking certain actions at the point of care vs. not (opportunity cost).
Efficiently analyzing a patient’s medical records can transform data into insights, improve care delivery and health outcomes, add value and lower costs. The data can also alert care providers to a patient’s social determinants of health (SDoH), enabling them to address broader healthcare concerns. These issues include economic insecurity, lack of proper nutrition, income instability, lack of safe housing, lack of reliable transportation and social isolation/loneliness.
It’s possible to maximize an EHR’s capabilities by using a browser extension that’s also a comprehensive, dynamic population health solution that creates a care, quality and risk continuum. The concept is to aggregate data from every possible source to illustrate the patient’s health status, needs and gaps in care to impact and manage risk. This demands an intelligent platform designed to drive value by reducing the cost of care, improving quality scores, ensuring risk adjustment accuracy and simplifying healthcare navigation.
Look for a web-based tool that’s available at the point of care and has connectivity capabilities that allows EHRs to reach their full potential. The platform enables payors and providers with insights that impact Medicare Advantage, Medicaid and commercial value-based care initiatives and is available as a Chrome browser extension that can operate on any web-based EHR.
Checklist of EHR browser extension
The right browser extension enables providers to access all data from a single source, improve workflow and provide exemplary patient care.
Key factors to look for include:
- Sits on top of any web-based EHR
- Uses patient matching when on top of an EHR to pull the correct patient and their relevant data
- Sends alerts to providers within their existing workflow, and
- Eases workflow and provider administrative burden by eliminating the need to toggle between different platforms.
Ultimately, the best browser extension should be designed to optimize the way information is shared, enhance how programs are implemented and improve care delivery. It eases workflow and provider administrative burdens by eliminating the need to constantly switch between different platforms, further streamlining the pathway to improved patient outcomes.
What’s more it should provide insights to expedite the transformation to value-based contracting and risk-sharing for providers and their partners. Providers receive alerts within their existing workflow so they can remain compliant with all interoperability rules and regulations.
At this level, a browser extension should illuminate operational and clinical efficiencies, enhance connectivity, move clinical quality metrics and support risk adjustment accuracy. Most importantly, it should create patient engagement to drive better health outcomes and the best possible economic performance. Think of it as a crucial tool for providing value-based care.