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Harmony Miller
Harmony Miller
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Electronic Health Record (EHR) Incentives & the Patient Experience

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Hundreds of thousands of practices and hospitals have foregone bulky paper charts in favor of electronic health record (EHR) systems. Electronic health records (EHRs) have become a necessity for large scale health systems and a way to keep more thorough, timely records for patients.

The Centers for Medicare & Medicaid Services (CMS) recognize the value in using EHRs, having established “meaningful use” incentives to encourage providers and hospitals to make the transition to this technology as part of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act. The incentive focuses on improving patient outcomes through the meaningful use of technology in the medical setting.

The goals for increasing meaningful use have been lofty; just this year CMS Administrators and Farzad Mostashari, M.D., National Coordinator for Health IT, announced a goal to have 100,000 new providers enrolled in the program by year’s end. That goal was reached months ahead of schedule: over 100,000 received the incentive by June, 2012.

Not everyone is happy about the incentive payments though. The U.S. House Ways and Means Committee recently asked HHS to suspend the incentive payments, claiming that providers were being asked to do too little to quality for the payments and that HHS was “squandering taxpayer dollars” by providing incentives. The claims that the incentives have been wasted seem to focus largely on too low a standard and the fact that the program has largely been concerned with increasing participation into EHR programs. Given the exorbitant cost of technology and implementing a new system for health systems, the incentives are a way to encourage participation and reward those practices that have been objectives outlined by CMS.

Absent incentive payments, it appears that EHRs have a tangible benefit to providers. A recent research letter published in the Archives of Internal Medicine claims that EHR use in Massachusetts led to a drop in liability claims. The data fails to show a causative relationship, but there is at least some evidence that use of EHRs may positively impact the patient experience and provide for more detailed records.

The discussion of whether incentives should be provided and what benefits they may provide on the technical and financial side cannot lose sight of the importance of patient experience. While EHR technology does allow for immediate access to the chart for providers and real time updating (waiting for the medical transcriptionist to dictate a chart note becomes antiquated), many doctors are realizing that having the best technology does not necessarily mean that implementation of EHR systems will improve their patient’s experiences.

A recent article in the American Medical News explored how “common blunders” associated with EHR implementation “can alienate” patients. The article addressed the side of EHR that has less to do with technology and more to do with the users—the doctors, nurses, medical assistants, and billing staff that must learn a new system and way of performing their work. There are many areas where implementation of a project of this scale (and expense) can be improved in order to maintain sanity and positive patient experiences. No one wants to visit the doctor just to sit and watch someone focus on a computer screen searching for information. Likewise, most patients value having the one-on-one interaction with their doctor; when that dialogue is interrupted by a computer and the already limited face time with the physician is diminished, patients may feel that technology is impeding their ability to get quality attention and care with their doctor.

Patients may also need to become their own health advocates as EHR becomes more prevalent. Just as the electronic record may provide the physician with more information, it may also make it more difficult to review the patient’s chart or lead to merely checking boxes rather than having a detailed discussion about a patient’s complaints. A recent visit to my own doctor led me to these considerations. I asked whether I needed to have a test repeated and as he reviewed five years of records that led to his recommendation to get the test repeated, I realized that had I not mentioned anything it is unlikely he would have been cued to look at the old chart system and those prior records, and would have not recommended the test. Patients must be aware of this and advocate for themselves in all encounters with medical professionals. Do not assume that because it was in your chart, or you believed it was in your chart, that your doctor remembers everything.