EMR: A Quiet Revolution - By Dr. Singh

Not too long ago having an EMR in a practice was a rarity. Within a decade, we have seen EMRs become the norm for a practice, thanks to the incentives for Meaningful Use and the soon-to-come disincentives for their non-use. Despite all their difficulties and deficiencies, EMRs are here to stay. Physicians who have not implemented them are expected to join the bandwagon in the near future. Already almost all of the graduates of residency programs are trained in EMR use, and it appears that EMRs will be part and parcel of the requirement for any medical practice.

When we study the evolution of EMRs, we see how the difficult and clunky efforts prior to Meaningful Use have transformed into a basic repertoire of modules in each system. Every good EMR is expected to have customer scheduling, billing and coding modules, E-prescribing, lab and radiology downloads, PQRS reporting, and dictation facilities.

Post-Meaningful EMR also saw an attempt to create HIEs across the nation. Unfortunately, those have not fulfilled their potential yet. We also saw EMRs becoming EHRs in order to provide data, reports, and diagnoses to patients and assist them in a HIPAA-compliant way to request prescriptions, schedule appointments, and summarize medical conditions.

It appears that the next phase will see an enhancement of these functions. It also seems that EMRs need to evolve in order to be able to be of use in the next federally-directed shift in healthcare, i.e. ACOs and PCMHs. Until now, the EMRs have not been able to keep up with the requirements for ACOs and PCMHs; hence the need for all kinds of data mining and reporting systems that are proliferating in the market.

It appears that as ACOs grow to acquire a greater share of the market, EMRs will adapt rapidly. We are beginning to see the shift in thrust from them merely being a record-keeper to being a record-analyzer. This enhancement will also be useful for providers and groups that take part in Medicare Advantage programs or other shared savings plans.

In fact, since the essential principles of ACOs and Medicare Advantage plans, or even commercial and Medicaid plans, are converging toward a greater demand for quality, compliance, utilization, evidence-based medicine, reporting and data analysis, along with greater fiscal responsibility and analysis, the next phase of EMR development, which has already begun, may be called the 'Third Wave' of EMR development.

This 'Third Wave' will incorporate newer functions that may make data retrieval easier. Dr. Montashari has already strongly advocated apps that will pull claims histories and diagnoses for seniors. But it is obvious that any greater advance will incorporate more than just apps and use of mobile devices for the same.

These advances will be such that EMRs will become a platform for all functions that a physician needs in order to see patients, schedule appointments, dictate notes, and send the billing out or send prescriptions. EMRs will also allow the physician to be able to see his credentialing status, or pull ACO data status, or PCMH criteria and their fulfillment, or look at financials and utilization.

In short, the EMR will help the physician run his whole office by integrating all the functions needed for an office to run efficiently and profitably. Some of these additional functions will include the following:

  • Credentialing: Without knowing the status of the provider's credentialing, no proper billing can be done and no financial projections can be made.
  • Auditing and pre-billing: These will be limited not only to FFS claims but also to Managed Care services, including MRA calculators, billing for HEDIS criteria, and creating projections for funding.
  • Referrals: A proper review of financials for managed care is not possible until utilization is linked to referrals. In the past, physicians depended on data from plans which came a few weeks after a claim was filed, but this issue can easily be circumvented in a closely integrated network or ACO.
  • Business Intelligence: Just as there were attempts to design EMRs which could suggest improvement in documentation to the providers to improve their CPT levels or prevent cloning, the future EMR will be able to assist physicians with HEDIS, MRA, utilization, compliance, data analysis, reporting and financial reviews.
  • Clearing house functions: Good EMRs will be able to link directly with plans or CMS and bypass middle-men to get a greater handle of EOBs, ensuring that their claims reach the payers, and reducing their expenses, effort, and time needed for the processing of claims and MRA and HEDIS data.
  • Reporting: ACOs or PCMHs will need to provide reports to CMS on a regular basis. A good EMR will make this function easy with the use of one finger.
  • Care management and disease management: It is critical that utilization modules be a part of EMR and not wait for claims data from insurers to put financials together.
  • Cost: Hopefully as EMS evolves, the cost of buying and maintaining them, hosting them, and managing them will come down.
  • Community EMRs: Open Source EMRs that are easy to host and extremely inexpensive, while providing the efficiencies mentioned above, may be used for indigent care, rural areas, or entire communities.

EMRs are a revolution in healthcare that is far from over. In fact, the real advances are yet to follow. Hopefully, they fulfill their true potential and promise of lowering costs, increasing profitability, assisting physicians in providing better healthcare, and making healthcare more effective and efficient.

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