When meaningful use incentive dollars began being disbursed to specialty medical groups back in 2010, providers quickly implemented new practice management and electronic health record systems.

Fast forward 12 years and specialty practices now are replacing those legacy systems with next-generation platforms. Today, specialty practices are faced with many of the similar "legacy versus new" challenges that hospitals faced a decade ago, but there are lessons learned that practices can pull from to help inform these decisions.

Bill Lucchini is CEO of Nextech Systems, a vendor of EHR and practice management technologies for ophthalmology, dermatology and plastic surgery practices. The vendor serves 4,000 medical practices nationwide.

Healthcare IT News interviewed Lucchini to discuss gaps between legacy EHRs implemented by physician practices and today's technologies. He discussed what EHRs implemented by physician groups need to include over the next decade, and the differences between general practice physician and specialist systems that need to be considered as EHR technology evolves.

Q. You suggest there are gaps between legacy EHRs implemented by physician practices and today's technologies. What are those gaps, and how are today's physician practice EHRs filling them?

A. In today's EHR market, we are seeing several gaps – punctuated by trends happening across regulation, infrastructure, care coordination and patient experience that are impacting EHR technology.

The first trend is the result of a shift initiated nearly a decade ago. It began with meaningful use, and because of several IT infrastructure improvement programs at that time, many specialty practices rapidly adopted lower cost, generic EHR technology to be meet the requirements of those initiatives.

What later resulted from the implementation of these solutions was formative – the more generic EHR solutions weren't prepared for or continually developed to accommodate the requirements necessary for specialty practice-specific workflows. The impact was more than clinical and resulted in significant impacts to practice revenue, patient engagement and patient satisfaction initiatives, as well.

The second trend we are seeing – more broadly concerning infrastructure in its current state – is that practices are beginning to move away from server-based solutions toward software-as-a-service and web-based solutions.

Transitioning to a web-based solution is no longer a "nice to have," but now a requirement as offices grow to multi-locations and/or necessitate employees to look at data from home. A big driver of this change has been pragmatic and operational needs around remote and hybrid work.

Finally, specialty practices are becoming significantly more sophisticated as patient expectations of specialty practices rapidly evolve regarding communications, interoperability and process simplicity.

This means that EHR companies must anticipate and ensure the platforms are well equipped with both front- and back-office functionality that is well beyond what has been historically expected of specialty practice EHRs to incorporate and streamline the payments and revenue cycle management, patient acquisition and relationship management, and enhance the overall patient experience.

Changes in patient expectations alongside the ever-changing regulatory and compliance trends means specialty practice EHR providers must meaningfully lead and advocate for their client practices through a difficult, complex and rapidly evolving landscape.

To best support specialty services – such as those provided by ophthalmology, dermatology and plastics – which are inherently different than acute care services provided by a hospital system, future EHR technology is uniquely positioned to contribute to the development of global standards for interoperable applications that also employ health, social, economic and behavioral data to advance outcomes-based care and health equity initiatives.

Q. From there, where are the gaps going forward? What do EHRs implemented by physician groups need to include over the next decade? What do current trends in patient engagement, value-based care and physician burnout challenges demand of physician practice technology?

A. Today, services provided by ophthalmologists, dermatologists, orthopedics and plastic surgeons tend to be delivered as complementary services to the services provided in acute and ambulatory care settings. This lends the business of specialty care delivery to be inherently distinct from the care provided by a hospital or a clinic.

The predominant EHR technologies deployed in the market have focused on the inpatient experience with some accommodation for outpatient and clinic services, but largely unaccounted for are features nuanced for specialty practice workflows.

Over the next decade as healthcare becomes increasingly outcome-oriented, reliant on care collaboration, and motivated to provide an improved patient experience, modern EHR technology must account for these nuances and can't look to historical clinical workflows – many of which were informed by inpatient clinical workflows – to inform the future of electronic health record functionality.

Specialty practices have an increasing role in supporting both providers and patients in achieving quality health outcomes with an outcome-oriented perspective and supportive technology.

In the future, EHR technology must focus on simplifying the delivery of excellent patient care with the features and functionality to proactively address rapidly evolving market conditions.

There will be features to increase physician productivity and experience. Workflows that assist the automatic identification and interpretation of medical information from prior sessions, hospital records, laboratory results and other sources free up physicians' time to focus on their patients, rather than their computers.

Essentially, EHRs should not interfere with how physicians think and operate. Moreover, many physicians in specialty practices are simultaneously business operators as well, therefore this necessity to serve the physician experience is especially critical. A renewed focus on the physician experience also accommodates nuances for both large and small practices, which are experiencing unprecedented market pressure and staff turnover challenges.

There will be the ability to reduce operating expense. By increasing clinician efficiency and simplifying documentation, coding and billing procedures, EHR systems can help lower operating costs. Documentation solutions that allow for the rapid and effective capturing of visit information at the point of care can help to decrease or eliminate the requirement for transcribing services.

EHR technology can also gain insight from specialty practices by incorporating features that help to streamline front-office workflows by automating manual tasks while supporting the clinical and patient-facing functions of the practice.

There will be the ability to improve the patient experience: improved patient portals, easy access to administrative functions, care coordination abilities, educational components, communication tools such as chat/messenger/call, lab result access/integration.

Q. What are the differences between general practice physician EHRs and specialty physician EHRs that need to be considered as EHR technology evolves over the next ten years?

A. Future EHR technology will become increasingly prepared to service a future healthcare economy that is patient-centered and outcome-oriented if EHR technology evolves to build upon the dynamic functionality historically developed to support acute and ambulatory care while adding accommodations for the needs of specialty practices.

The gaps present today that specialty practice workflows can aid in advancing EHR technology include improved charting features in service of care collaboration and clinical referral workflows; proactive accommodations to manage inventory to ensure that supplies, equipment and medications are available for services; and front-office support for scaling practice growth and managing patient relationships beyond the clinical interaction.

With these features accommodated, the potential for EHR technology to evolve beyond transactional use cases is both encouraging and profound.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.