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Adapting EHRs for the 21st Century


There is a great deal of speculation, and apprehension, in the healthcare industry about the 21st Century Cures Act and what it will mean for EHRs and the clinicians who use them.

There is a great deal of speculation, and apprehension, in the healthcare industry about the 21st Century Cures Act and what it will mean for EHRs and the clinicians who use them.

Consider the sources of anxiety: It will result in new reporting requirements, the need to manage multiple terminologies and code sets, the sending and receiving of clinical data, curation of incoming data, and (almost lost in the frenzy) improving usability as the industry moves to value-based care. Understandably, the cumulative effect has much of the industry on edge.

Now, factor in the issue of data transparency as patients are given access to their records, the added considerations of social determinants of health (SDOH), and the pressure to improve patient clinical outcomes. Throw in additional coding and documentation requirements, and it is no wonder we are seeing more burnout among physicians, nurses, and other allied health professionals.

Large, enterprise-level EHRs are not going away. Hospitals and health systems have made significant investments here, so they are being forced to adapt these systems to the new realities of 21st Century care. Current adaptation strategies include the use of ambient AI with machine learning, scribes, population health management, and curation of data in the medical record. However, very little is being said about improving EHR usability at the point of care.

Clinicians are among the most highly-skilled knowledge workers in the world––trained to process information diagnostically, ascertain a patient’s clinical status, and determine the best course of care. Much of the information they need to support the clinical thought process is in the EHR and, unfortunately, coded into disparate terminologies, making it very difficult to see comprehensive diagnostic views.

One common approach is to use a terminology, or vocabulary server, to classify the different domains of clinical data, using ICD-10, CPT, SNOMED, LOINC, RxNorm, HCPCS, and others. In most EHRs, these are presented in separate, distinct sections––forcing users to navigate to different “tabs” or views to access relevant information. The good news is that much of the information is already codified, so all that is needed is a way to pull together the relevant information for any given problem and present it to the user.

As enterprise EHR vendors have begun opening their systems to enable the integration of add-on applications, a new wave of innovation is emerging to provide usability improvements for clinical users. These new enabling technologies must support the standard terminologies and code sets mentioned earlier. Multiple terminologies are required by the 21st Century Cures Act, electronic clinical quality measures (eCQMs) reporting, and revenue cycle management systems. So, the challenge is pulling these disparate terminologies together into a clinically usable view for any patient at the point of care. Ideally, this new crop of solutions will enable clinicians to:

  • Access a unified clinical summary organized by clinical problem, showing related medications, lab orders and results, therapies and procedures, history including SDOH, physical exam findings, and co-morbidities for any problem––all with a single click.
  • View which clinical quality measures, including eCQMs, are applicable, if they have been met and, if not, to prompt the clinician for what needs to be done (or documented) to satisfy the measure. This should also be possible after the fact, by a chart reviewer. Ultimately, there no better time to do it than during the face-to-face (or virtual) encounter with the patient.
  • Determine (for Medicare Advantage patients) if any diagnoses qualify for risk adjustment using the hierarchical condition codes (HCCs) and if the documentation meets government requirements for management, evaluation, assessment, and treatment of each diagnosis.

These capabilities are a good start to improving clinical usability at the point of care. And as new solutions emerge, and the EHR vendors continue to open their systems to enable collaboration and innovation, this could go a long way toward alleviating much of the anxiety surrounding the 21st Century Cures Act.

David Lareau is CEO of Medicomp Systems, which makes medical data relevant, usable and actionable.

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