Physicians, healthcare organizations facing EHR compatibility trouble

The push to convert to electronic health records (EHRs) has hit a stumbling block in Vermont, with reports of compatibility issues and some inaccurate information.

The state legislature’s Health Access Oversight Committee recently heard from Hunt Blair, Health Information Technology Coordinator for Vermont. Blair told state officials that they are experiencing difficulties because their efforts have placed them on the bleeding edge of technology, which has led to compatibility issues as new systems come online. While EHRs can improve patient care and be used to amass valuable data on physician and hospital performance, technological bugs are standing in the way.

Blair indicated that the federal government failed to establish standards quickly enough to ensure compatibility. As a result, the systems that different physicians and hospitals use may not be able to communicate smoothly. One problem, the official noted, is that data such as blood pressure may be recorded as text in one system and as numbers in another. This impedes or prevents the smooth transfer of even the most basic patient data at times.

The state has invested nearly $70 million into EHR development and implementation, according to Vermont Public Radio. Lawmakers are eager to see positive results and healthcare stakeholders are growing frustrated with these problems. Some say they should have been prepared for these issues and predicted them at the beginning of the effort.

Implementing EHRs smoothly

 Officials and healthcare stakeholders in Vermont and other states are looking to the Office of the National Coordinator for Health Information Technology and other federal agencies for guidance on standardization, to lead the effort that will resolve these issues. At the same time, EHRs are new enough and at a sufficiently early stage that further issues are likely to arise as new developments occur.

Physicians should be certain they have the latest federal and state information on EHRs. Keeping up-to-date on government guidance, communicating with colleagues and other healthcare organizations and similar steps could help avoid compatibility issues.

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Study: Patients often unprepared to disagree with physicians

One major challenge physicians may face is patients’ reticence, which can interfere with the decision-making process.

Most patients are hesitant or reluctant to disagree with their doctors. While confidence in medical experts can reflect trust and be beneficial for the physician-patient relationship, it may also result from fear. A study published in the Archives of Internal Medicine found that only about 14 percent of patients would be prepared to disagree with their physicians if their own preferences differed from professional treatment recommendations.

That was found to be the case despite 80 percent indicating they had the ability to disagree and 90 percent responding that they felt comfortable asking questions or discussing preferences. Those unwilling to go against their physician’s advice said they would not wish to damage the trust between doctor and patient or feared being perceived as difficult. More than half thought that they might compromise care by doing so.

This state of affairs could hinder clear communication between physicians and patients and lead to inferior health outcomes. While there is no single way to guarantee that all patients will be reassured of their own ability to play a role in determining their care, this issue should be kept in mind. Physicians and staff members may wish to think about how to ensure they are perceived as accessible and helpful, promoting an appropriate degree of patient autonomy.

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Adjusting to the emergence of new payment methods

As the healthcare industry moves away from the fee-for-service model of payment and toward a budget-based payment system, physicians will face both risks and opportunities.

The Patient Protection and Affordable Care Act (PPACA) and other legislation may play major roles in changing the relationships between patients and healthcare organizations, in particular the promotion of accountable care organizations (ACOs) and other systems that financially reward physicians for the quality of care rather than volume. Fee-for-service models are still the most common, so any transition away from them will take time, Medical Economics notes.

For physicians, it may be necessary to choose between alternative payment methods such as pay-for-performance, capitation, bundled payments, risk pools, shared savings and more. Some of these may wane or rise in popularity as professionals and patients gain more experience with them. Some methods are essentially hybrids, based on fee-for-service care but with additional payments earned if quality and cost milestones are met.

Other methods may set aside portions of contractual payments for release only if physicians meet pre-determined goals, rely on a flat fee for a certain package or set of services or have per-member monthly fees.

 

Physicians’ financial risks

 

All of these methods require physicians to take on increased financial risk, though the extent to which that is true varies. Budget-based payment requires physicians to estimate their patients’ future use of services and their own costs, then manage care to remain within budget.

Although some physicians may feel pressured to set their future course as soon as possible, it may be better to take a slow approach. To the extent that is an option, it may allow a more gentle transition and help keep the practice on an even footing.

Some experts say that the main reason budget-based payment may be successful when past attempts were difficult is that improved technology will allow physicians to better track and use data on their patients and their own practice to estimate their risks, expenses and other factors. Stronger healthcare IT resources can also prove useful in managing a patient population and for purposes such as accounting, allowing a practice to run more efficiently and avoid being buried under data and details.

 

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Employee-physician trust vital to run a successful practice

Building trust and loyalty with staff members can be key to success, helping physicians in both the business and medical aspects of their work.

A lack of morale or trust in management can cripple a practice by encouraging stress and damaging productivity, as well as spilling over into the relationships between patients and staff members or patients and physicians. It also tends to affect turnover, with further effects on the business as bringing in new people too often can be disruptive.

Part of building trust is ensuring that employees understand what is expected of them. Clear communication about their duties and performance is a necessity. At the same time, clarity should be complemented by praise when personnel perform well. Physicians should be aware of employees who are consistent over time as well as those who show improvement, as the former is easy to overlook but can be exceptionally valuable.

Physicians who are not successful in building trust with their employees may find that they have to cover for departing or absent employees, fill vacant positions and generally spend a lot of their time and resources on short-term solutions to what is essentially a long-term problem. Success, on the other hand, can be self-sustaining.

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Physicians may be challenged to balance evidence and intuition

As electronic health records (EHRs) with decision support and evidence-based guidelines become more prevalent, some in the healthcare industry are concerned that there will be less room for physicians to exercise their own judgment.

Guidelines are limited in that they can only address a finite number of concerns and do not account for patient fears and desires, experts told Medical Economics. Because of that, physicians’ intuition will remain a valuable tool as they practice, particularly with respect to diagnosing health issues. One reason for this is that patients’ body language, tone and other factors, as well as their words, may convey important information that guidelines cannot account for.

When asking patients how much pain they are experiencing, for example, the same words may carry different meanings depending on the particular individual. A physician’s past experience with a patient can make it easier to interpret his or her response beyond the scope of guidelines.

Amy Compton-Phillips, MD, associate executive director of quality at the Permanente Foundation, noted that most checklists are designed to help physicians remember options that they should try. They are not intended to discourage them from exploring alternatives that are not mentioned. To that extent, they may support evidence-based patient care without preventing physicians from using their professional judgment.

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GAO suggests further guidance needed from HHS

The Government Accountability Office (GAO) recently indicated that the U.S. Department of Health and Human Services (HHS) has not done enough to provide guidance and oversight for protected health information (PHI).

While HHS has issued regulations, including those tied to the Health Insurance Portability and Accountability Act, it does not help covered entities sufficiently. This is a major issue as many healthcare organizations are creating and transferring electronic prescriptions. That data constitutes PHI, and HHS has not issued required implementation guidelines to deal with PHI, particularly when it is not being immediately used to provide healthcare to an individual.

Specifically, the GAO says HHS needs to establish a sustainable auditing program and to educate people about the uses of PHI, as well as the rights people have in relation to those uses and their potential effects. HHS agreed that these needs are present, indicating it has delayed action because of competing priorities.

Physicians should watch for further guidance from the department in the wake of these recommendations, and be prepared to ensure their practice is compliant with those that are applicable.

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Healthcare IT may help reduce malpractice claims

Physicians who use electronic health records (EHRs) experience fewer malpractice claims than those who do not, according to a study.

Despite the challenge of adapting to the use of EHRs, researchers at Harvard Medical School found that the benefits might extend beyond reducing healthcare costs and adverse events and also impact malpractice lawsuits. Published in the Archives of Internal Medicine, the study demonstrates what could be a meaningful correlation.

“Risk factors for medical error and resultant malpractice claims, including poor communication between providers, difficulty in accessing patient information in a timely manner, unsafe prescribing practices, and lower adherence to clinical guidelines, may be ameliorable by health information technology,” the report notes.

Researchers examined the malpractice claim history of a number of physicians over time, finding that they were much less common after EHR implementation than before. The study reports that the rate of malpractice claims at practices using EHRs was one-sixth the rate of those without them.

Further research may be necessary to determine with certainty that the EHRs are responsible for these benefits. Despite that, this may encourage physicians to speed their implementation efforts. Those experiencing difficulties in financing the change, which can be a significant expense, may want to investigate loans for physicians.

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SCOTUS rules on PPACA

The Supreme Court of the United States has issued its long-awaited and much-discussed ruling on the Patient Protection and Affordable Care Act (PPACA).

The individual insurance mandate that requires American adults to purchase coverage beginning in 2014 has been upheld as constitutional, and most of the law’s provisions are intact. Although the court did not agree with some of the arguments made in support of the law, the final opinion found that the provision was within the authority of lawmakers to pass on the grounds that it could be considered a tax. This decision will have far-reaching long-term effects on the healthcare and insurance industries, as well as individual consumers and physicians.

If the provision is successful in extending health insurance coverage to millions of Americans who currently go without it and improving on current standards of coverage, physicians may experience an increase in the number of patients who use their services.

This could benefit practices across the country, particularly if possessing coverage encourages more Americans to seek regular care from primary care doctors instead of postponing care until they are forced to go to the hospital, which has been a growing issue. That trend has been named as part of the reason for increases in health insurance premiums. Physicians will likely find themselves making many adjustments to their practices in the coming years as a result of the court’s decision.

Provisions other than the individual mandate
The court did rule that part of the Medicaid expansion under the PPACA was not constitutional, however. While the justices took no issue with lawmakers providing additional funds to help states cover the cost of expanding the program, they did indicate that removing all funds in the event that a state failed to comply would not be constitutional.

The law’s broad nature and sweeping effects mean that it will likely take some time for all the effects of this ruling to become clear. One part of the legislation that will impact physicians concerns durable medical equipment (DME) and home health services, which are considered to pose high risk of abuse or waste. To combat waste, the PPACA contains language that allows the Secretary of Health and Human Services to revoke physicians’ and suppliers’ enrollment in Medicare if they fail to maintain and release documentation concerning DME and home health service use to the government upon request.

That provision may apply to other high-risk items and services in the future. At the same time, the ordering of DMEs and certification of home healthcare services for Medicare beneficiaries is being limited to physicians enrolled in the program.

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Physicians should consider uses of healthcare IT in improving efficiency, operations

Healthcare information technology can be used to strengthen the physician-patient relationship, according to panelists at the 2012 Healthcare IT Connect Summit.

Physicians should seek to do so as part of running their practice, panelist Kevin Flanigan suggested. In discussing accountable care organizations (ACOs), Flanigan indicated that healthcare IT infrastructure must be integrated into the decision-making process if it is to help improve patients’ health and reduce costs.

One major function healthcare IT can serve that will aid in this respect is to help physicians and healthcare organizations coordinate their care to avoid episodes of repeating and overutilized care. Different physicians, specialists and others may have difficulties helping patients due to problems communicating what they need and what treatments or analyses have already been performed.

It may help to look at services in terms of what their objective is. Changes to how a practice is run might be targeting cost reduction, care improvement or other goals. Doing so may help to clarify what effects those adjustments will have on a physician’s practice and patients. Data may also help if used to analyze how much of a practice’s resources are going to help each patient. This sort of analysis may be new, but medical lending could help physicians procure hardware and software to make it easier.

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Many more healthcare jobs will open up in coming years

The U.S. healthcare industry will need to create at least 5.6 million new positions by 2020 to meet demand for care in the coming years, according to a study.

More than four out of five of those new positions will need to be filled by individuals with post-secondary education and training, the Georgetown University Center on Education and the Workforce recently reported. New positions will include hospital accountants, information specialists and staff members at private practices as well as physicians and professionals providing actual medical care.

Researchers also found other developments are taking place in the industry, such as growing degree requirements for nurses and a rising percentage of them possessing such qualifications. As the healthcare industry and the U.S. economy as a whole adapt to these changes, physicians may find they need to alter some aspects of how they run their business.

Some, on the other hand, could find an opportunity to expand their practices. If the time comes to purchase new equipment, move to a larger site or make other significant changes, loans for physicians may be useful in financing the adjustments.

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