By Julie Mann on April 16, 2019
First period: Experiencing the Pain
As a college intern, I worked for a minor league hockey team in the marketing department, where I fulfilled traditional public relations duties and various others, such as: logging the plus/minus in the press box, carefully escorting National Anthem singers to center-ice, and one time, transporting an injured wingman to the next-closest emergency department. It paired well with my major in Business Administration and a concentration in Marketing. After college, I continued to work part-time for the hockey team, in addition to working full-time at a medical billing company. My dad is Canadian; he and his three brothers grew up playing hockey. My grandparents still follow their beloved Maple Leafs. My family’s hockey roots, my education, and my passions all seemed to align with my vision of a career in sports marketing. But after four years with the hockey team, I realized it was not the work/life balance for me. I instead shifted all my focus to my medical billing job and sharpened it into a career.
My career in healthcare started in a cube in the Accounts Receivable department. Every morning by 7:00AM, my daily work began with opening mail for my assigned accounts and sorting it into logical piles on my desk. I would log into IDX’s Group Practice Management System. I then would manually post the hard-copy payments to their corresponding balances in the GPMS system. Personal payments were easy and quick. Insurance company checks always came with a long explanation of benefits (EOB), which sometimes had hundreds of line items filled with patient health information data. I would use a piece of paper to focus my eyes and work down the page, each row – looking up the patient, eye-balling the date of birth/name/ID number to ensure a match, and then posting the payment, transferring or writing off the balance as indicated on the EOB, and using all of the proper adjustment codes. Often it would take me 4 hours “to post” a large EOB. It was mind-numbing work. When this painful process was replaced by electronic remittance, it was incredible! It saved a significant amount of time, dramatically improved accuracy, and freed me up to move onto another position. This was 2002.
Second period: The Faceoff
It is interesting to observe the positive friction of technology gliding into healthcare. On one side are the “tech lovers,” and on the other are the “tech haters,” and then a whole bunch in between. The issue of administrative burden resonates with me, and I can recall several personal experiences (like posting those onerous EOBs) that make me cringe, thinking of life before tech in healthcare. I’ve always had the mindset of “skate to where the puck will be.” Today, I am focused on delivering innovative tech to value-based care organizations to surface contextual insights into the workflow. Physicians and their extended teams face enormous administrative burden with the transition to value. It is our responsibility as part of the healthcare information technology community to shield users from unnecessary administrative burden.
“Death by 1,000 Clicks: Where Electronic Health Records Went Wrong” is an epic tale of the dire predicament caused by the rapid EHR adoption triggered by a well-intended, government-sponsored incentive program. The goal was reasonable – to offer a “carrot” to entice and expedite the migration from paper records to digital. In the article, Seema Verma, the current chief of the Centers for Medicare & Medicaid Services, calls out the obvious miss: “We didn’t think about how all these systems connect with one another. That was the real missing piece.” The average health system has over a dozen EHRs; couple this with an estimated 1000 EHR vendors, as well as with the fact that the majority of physicians are on an EHR today, and the result is a perilous mass of siloed data – by instance, by type, by intent, etc. Then, mix the EHR environment into the broader healthcare IT ecosystem, and the data issue is compounded almost infinitely. Reading Forbes/Kaiser Health News’s article brought back memories of my experience at McKesson from 2008 through 2012, where I was selling EHRs throughout Florida. Back then, in my initial conversations with physicians, it was easy to determine if they were on team “tech hater” or “tech lover”. The first group would either flat out dismiss the need for EHRs or outline their plan to retire before it became a mandate. The others were optimistic about the potential to free up resources, leverage voice-recognition to minimize typing, automate wellness visits reminders, access a patient’s chart from anywhere, convert medical record storage into exams rooms…and more. It was fun to work with the second group – they were the visionaries of the time: embracing tech to make healthcare more efficient.
No doubt, change is hard. No doubt, moving from a paper-based record to an EHR was challenging. But, the situation is more nuanced than Forbes/Kaiser Health News’s article implies. An alternative perspective, authored by Mark Braunstein, MD, provides a strong balance to the conversation: “Death by 1000 Clicks Redux.” Dr. Braunstein starts by recounting a haunting personal experience of a manual error that could have been evaded by an EHR. Braunstein also explores the challenges of administrative burden placed on physicians — it is not exclusively due to the EHR vendors’ poor user experience or to “spaghetti code,” but also connected to “the need to obtain more data on the reasons why expensive tests and procedures are being ordered in an attempt to reign in out of control health care costs, and for the quality measurement and reporting purposes to support new ‘value-based’ reimbursement of care.” Braunstein also presents the progress around improving interoperability through the use of standards. Braunstein also cites the positive impact on patient engagement. How great to have access to your online health data from your phone? I recommend reading his “Redux” as a supplement to the Forbes/Kaiser Health News article to have a more balanced faceoff on EHRs.
Just google “EHR benefits,” and in less than 5 seconds you are presented with over 11 million results, but most are negative. In both the articles referenced above, numerous challenges continue to surface and are shared in various flavors in the search results. Even with the challenges and complexities in the EHR space, significant mergers or new entrants continue with the most notable in late October 2018 with UnitedHealth Group’s announcement of plans to offer an EHR to their 50 million members in 2019. UHG intends to streamline data exchange and empower better care through transparency.
The reality is:
- Digital healthcare data is growing exponentially
- Numerous barriers in exchanging healthcare data exist, compared to other industries, and must be maneuvered around
- Thousands of vendors and various purpose-built systems serve a need and will remain
- Innovation is needed to improve the usability across technologies
Third period: Skating to Where the Puck Will Be
Considering the current user experience with the EHR, layering in other technologies does compound the administrative burden placed on physicians and their care teams. Regularly physicians must leave their EHRs to access essential pieces of patient data in order to deliver care, make informed decisions, and/or satisfy value-based care mandates (to site a few examples). Crucial pieces of the game plan typically reside outside of their workflow. Providing physicians with tech to enable engagement is critical – health systems, health plans, accountable care organizations have all invested in EHRs and analytics, but if physician workflow isn’t optimized, tools won’t be used – and assets sit producing zero value.
KLAS lays out the criteria for vendors to achieve “basic” through “advanced” clinician engagement for population health management solutions in their report: Population Health Management 2017, Part:1. In the sea of PHM vendors, as in the industry for any piece of technology, each vendor has unique strengthens and weaknesses. KLAS is one of the tools to help buyers identify which PHM solution best suits their needs. The six verticals from KLAS’s “The Population Health Management Framework” are:
- Data Aggregation
- Data Analysis
- Care Management
- Administrative and Financial Reporting
- Patient Engagement
- Clinician Engagement
Regardless of the PHM strategy in place, clinician engagement is required. Organizations must have the PHM data activated at a population-level and at a patient-level. By surfacing contextual information into the workflow, physicians are seamlessly presented with curated information needed to win. If your analytics aren’t in the workflow, it doesn’t matter how good they are – they will sit pretty in a portal and become irrelevant.
Overtime: Put the Puck Where They Want It
Vendors can immediately satisfy the requirements of clinician engagement through a partnership with Holon. Holon is not an EMR, nor an analytics platform. Instead, we empower those “investments” by exchanging contextual data to the right people at the right time – in the workflow. Holon believes in partnership and collaboration to make healthcare and healthcare IT work better for all (in keeping with the hockey analogy, think of us as a “Steven Stamkos” of sorts, a key player who–when added to a coordinated team, with a solid strategy–is a winning combination.)
We’ve reimagined interoperability. Our point of care platform, CollaborNet®, automatically detects when a patient’s chart is opened and retrieves critical, real-time data from outside the EHR. Holon then activates analytics by surfacing insights at the point of care, right into the workflow. We bring a new solution to old problems. Physician engagement improves due to our seamless, automated user experience. Because the provider now has the data they need while the patient is in context, they have the information needed to make the best treatment decisions and can spend more time with that patient, on average 5 more minutes per patient, collaborating and engaging them about their care.
Contact us to get a copy of our white paper which details the requirements of KLAS’ Clinician Engagement vertical and learn how Holon satisfies each feature. Let’s put the “puck” where they want it. With all the administrative burden placed on physicians and frustrations with the current state of healthcare technology, let’s remove clicks by infusing contextual awareness to surface meaningful information into the workflow. Every little bit helps; let’s be part of the team to make physicians’ lives better by shielding them from as many clicks, systems, and steps as possible. Join us as we liberate the data to liberate the care.