Not All EHR Are Created Equal

Having written about EMR and EHR software for 15 years, it’s amazing to think how far we’ve come.  When I first started writing about EMR software, we were also talking about putting high speed internet and wifi into the office as well.  Then, the HITECH Act provided $36 billion of stimulus money and required EHR certification.  In many ways these certifications gave physicians the impression that all EHRs are the same.  While this may be true from a certification standpoint, from a usability and feature standpoint, it couldn’t be further from the truth.  Plus, many companies have pushed well past the EHR into other software that really makes a medical practice more efficient beyond the clinical documentation.

The reality in the world of EHR software is that there are companies who have spent the time and money to continue evolving their user interface and feature set and there are those that haven’t done so.  This was what came to mind when I sat down with Tim Costantino, VP, Head of Product at AdvancedMD, to talk about their suite of medical practice solutions including their EHR, Practice Management, and Patient Engagement solutions.

The reality as I talked to Costantino was that many doctors and medical practices think that the bad workflows they experience every day are just normal.  They don’t know that there are better workflows out there that would make their work lives better.

A great example of this is many doctor’s need to be a 24/7 doctor.  They don’t want to be, but many of them need to access their EHR in off hours.  An example of a bad workflow is having to remote desktop into your computer in the office to access your EHR.  Even worse, some doctors are still driving into the office to access their EHR.  A better workflow is a unified solution that’s in the cloud and available on mobile.  This way a doctor can quickly get access to the information they need to better serve patients at any time and in any place.

Costantino shared another example of how the right visual indicators can help a doctor’s workflow be more efficient.  If you take a look at the AdvancedMD physician dashboard screenshot below, you can see a series of circles (they call them donuts), which give a simple visual indication of what tasks still remain for the doctor.  Not only does this provide a visual representation of the work that remains, it also provides easy access to be able to complete those tasks.  Plus, as a doctor completes their work, they get the visual satisfaction of seeing these “donuts” go to zero.

Another example of not all EHR user interfaces being equal was a look at the virtual patient chart in AdvancedMD.  You can see an example view of a test patient below.

What I love about this interface is that it provides a mix of two very important views of the patient.  On the right side you can see an overall view of the patient through a number of drag and drop patient cards or dashboards that summarize the key information about that patient such as medications, allergies, problems, etc.  Of course, these can all be moved around by the doctor to their own exacting needs.

While the patient specific dashboard is great, you’ll see on the left side a timeline view of the patient’s medical history.  This provides a doctor a nice visual view of the patient’s healthcare over time that often is harder to see and understand in a dashboard view.  Plus, it allows for easy access to specific notes, lab results, etc that may need to be reviewed during a patient visit.

What’s also interesting about these views is that they integrate relevant data from the practice management system for immediate visibility into things like patient appointments including the ability to schedule future appointments.  Many medical practices that still use an interfaced PM and EHR don’t realize the benefits of having both the PM and EHR on the same platform.  Not only do you avoid data integrity and double data entry issues, you also have a seamless view into the patient from both a clinical and business perspective.  Plus, having one platform allows for deep integrations with things like intake forms that are integrated right into your chart which can save physician’s time re-documenting the same info.

As many practices have faced cash flow challenges amid COVID-19, the importance of the right integrated payment collection process has been highlighted.  Making sure your practice management solution provides for things like online statements and text and email reminders (with no login for payment) has become essential to ensuring medical practices are collecting payments effectively.  In fact, most practices are moving to a credit card on file option to ensure payment collection.  Although, even then credit card on file needs to be done at a high level that takes into consideration things like multiple credit cards (HSA and personal) to ensure a great experience for the patient that doesn’t cause more hassle for your billing staff.  Having all of this integrated into one platforms has proven beneficial for telehealth visits as well where you can collect the telehealth visit payment as part of the telehealth visit.

Looking Forward

Those are a few examples of medical practice software features available today that many don’t enjoy because they are still using a software that hasn’t implemented a more advanced UI or feature set.  While these are extremely important and can impact your day to day experience, where your medical software vendor is headed in the future is probably going to be even more important.  Let me give a few examples to illustrate.

While we’d love our EHR vendor to provide every service imaginable, that’s just not reasonable given the unique needs of each practice, specialty, etc.  This is why how an EHR vendor approaches integrating their software through an open API that can easily access your PM, EHR, and Patient Engagement tools is so important.  If you think all EHR APIs are created equal, you’ve never tried to integrate with them.  Ask your favorite third party vendors which EHR vendors have the best API and you’ll know.

Another area to watch is BI (business intelligence) and analytics.  While most EHR have had some sort of reporting option available forever, the opportunities available in this area have never been better.  Talking with Costantino from AdvancedMD, he highlighted how important it was for these solutions to be out of the box practical for a medical practice and easily customizable to the practice’s own unique needs.  The solution also needs to be integrated across EHR and PM in order to solve real business and clinical problems.  Seeing that trend data month over month can be used for provider accountability.  Plus, the right solution should identify outliers.  For example, it may identify an increase in no-shows which could cause a problem on the business side.  Having the right data and making it actionable is where the best vendors are focusing.

Other areas where I see EHR and PM vendors pushing forward is on things like online self-scheduling by the patient.  The solution needs to be customizable to the needs of the practice.  Costantino highlighted that some medical practices prefer to do an “intake first” offering where they can pre-screen the patient before allowing them to schedule an appointment.  Others want to allow patients the option to schedule an appointment directly with automated screening.  Plus, the right self scheduling tool will need to navigate when a telehealth vs in-person appointment is scheduled.

While I’ve already mentioned the benefit of intake forms being integrated with the EHR to help make a physician’s documentation more efficient, this is just the beginning of what I call smart intake forms.  Right now most of these intake forms are pretty static with some basic branching based on previous responses.  The next generation of smart intake forms is going to be an AI bot asking personalized questions based upon past history, sensors, etc to really automate the documentation collection process.  If you’re still using paper forms scanned into a PDF, how are you going to be able to benefit from these new smart intake forms?  We need to make the intake process and waiting room more effective and that requires being on the latest technology that can support these new workflows.

No doubt there are a lot of other areas I haven’t pointed out.  For example, will you need your EHR and PM software to support a subscription model?  How are you going to approach value based care and chronic care management?  Is the software you’re using keeping an eye on these programs and other population health initiatives that may be necessary for your success in the future?

I can’t tell you how many times I have someone comment on the site or reach out to us and say that they wish that their EHR could do <insert feature>.  Most of the time when they do this, I know an EHR that does just what they describe.  While it’s easy to think that all EHRs are created the same, that is simply not the truth.  It may be worth the extra effort to look around and see what else is out there that could make your life and your workflow easier.

About the author

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

   

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