Value-add

Time will tell what the real impact of the consumer data revolution will be on EHRs. In the meantime, the systems are starting to evolve in more practical ways to meet the needs of their clients. 

In August, for instance, Greenway announced that it had received a new patent for "clinically driven revenue cycle management" – a function in PrimeSUITE, its practice management and EHR, that automatically aligns billing codes with payer- and location-specific fee schedules.

With this "location-driven bill coding," PrimeSUITE populates the EHR with the patient's payment method and the provider's geographic location. When certain data is plugged into the EHR, PrimeSUITE assigns an allowed service cost consistent with the payer fee schedule for that provider's location.

The functionality is meant to help providers navigate "the growing complexity of payer models, including variations among payers and U.S. regions," said Greenway CEO Tee Green, in a press statement. Greenway officials note that the innovation points to "yet another way in which the data collected in EHRs can deliver tremendous value."

Another evolution is happening with data exchanges – with more and more EHR developers deciding to embed HIE tools directly into their software workflows.

"Increasingly, vendors are fueling the demand from providers to come up with health information exchange solutions," Micky Tripathi, CEO of the Massachusetts eHealth Collaborative, told Healthcare IT News in September.

"They're saying, 'If my providers are demanding health information exchange, I'm going to come up with health information exchange solutions,'" he added. "But I'm not going to assume there's going to be a nationwide network of health information exchange organizations that I'm going to have to rely on in order to interoperate with other providers or vendor systems in this community.'"

The next couple years will be interesting to watch as the demands of the healthcare marketplace evolve – perhaps differently in some regions, compared to others – and the technology does too.

"I think we're looking at a world where the health IT will be a lot more modular," says Mark Segal. "It will be more and more resembling what we see with apps. And I think we'll also be increasingly looking at a world where we'll have specialized health IT – a population health management application, an analytics package – that will integrate either tightly or loosely with sort of a core EHR."

It's happening already, of course. In August, our sister publication, Medical Practice Insider, spotlighted seven add-ons that can be integrated with an existing ambulatory EHR system to enhance its performance in specific areas. These include apps that offer speech recognition capabilities, the ability to access cross-speciality images and even help with transferring clinical data for patient referrals.

Give the providers what they want

When we spoke with Maria Ryan, RN, CEO of Cottage Hospital, a 25-bed critical access facility based in rural New Hampshire, about how her hospital was able to successfully attest to Stage 2, we asked her to weigh in with a wish list for what EHRs might feature as they evolve over the next few years.

"You can't see me," she said over the phone, "but I have the biggest smile on my face. I've always known what I've wanted."

Having been in the business a long time, "I've seen how clinical people struggle," Ryan said. "Nurses, doctors, everybody. All of them talk about time away from the patient, how much more time it takes to be on the computer.

"I've always envisioned, sort of like Star Trek, this thing on a lapel," she said. "When you go into a patient – 'Hi Mrs. Smith, yes you were admitted yesterday with pneumonia, this is the antibiotic you received, let me listen to your lungs ... they're clear' – that would automatically go into the note."

"Of course you'd have to proof it and sign off on it," said Ryan. "But any clinician – doctor, nurse, respiratory therapist, anyone – can see a clinical picture of the patient, quickly and integrated: I can see that the nurse did her or his assessment in the past 24 hours, or how far the patient walked that day. Everything is quick and integrated. Ease of use, and much more voice recognition – I think that's the wave of the future.

For her part, Rebecca Weber, CIO of Neptune, N.J.-based Meridian Health, wants to see better biomedical integration with EHRs.

"It's happening, but not significantly," she says. "As we move forward with technology and genomics, the efficacy of certain drugs on an individual – those are going to be the types of things we're going to be looking at."

As Weber sees it, "the EMR is going to be more of a feeder system, into research and proper treatment of the patient, which is done at a higher level. To say that, if you have a patient and their XYZ levels are in this criteria and their pathology is this, then this medication is better if their genetics are within here.

"We're going to learn so much from this data," she adds. "I really see the future of EHRs being the foundation for us to learn more about the human body, and the ways we can treat the patients. I believe in the future a lot of this is going to relate to advancements in medicine and how you treat a patient with these genetics, this age, this type of pathology.

"That's where I see EHRs going," says Weber. "Not just to collect this, that or the other but to collect all the details and bring them up so we can understand why this CHF patient is different from this one, and how they can be treated, maybe differently, based on particular biomarkers they may have. EHRs will be feeder systems to our our growing knowledge."

'Waves coming'

When Healthcare IT News interviewed Siemens' John Glaser in the days after his company merged with Cerner, he was excited about the future. Already, he was looking to a not-too-distant point on the horizon where EHRs as we know them now are just a memory, not unlike the floppy disk or the dial up modem.

"We see this across industries and across time – that the technologies you put in place today, over the course of 10 years, become obsolete, or are certainly overtaken by new, cool, much more potent stuff," said Glaser.

Looking ahead, he sees "waves of replacements, because the technologies will just offer more opportunities," in areas such as population health and care coordination.

"So there's a series of waves coming: a revenue cycle wave, a population health management wave," he says. "But also next-generation of EHR wave that is probably a couple years out but coming nonetheless."

What will that look like? "You might have an EHR installed, but the underpinnings, and the way it's put together, are really different," Glaser posits. "In a lot of ways it will look the same: I can still write a prescription, look up results – those are core, atomic capabilities that will still be there." 

But beyond that, he foresees some fundamental changes coming down the pike. 

EHRs "will be much more intelligent," says Glaser. "I was a CIO for a bazillion years and have put in a lot of EHRs, and fundamentally it's a form of transaction: write a prescription, retrieve the results, document care."

But increasingly, "we're going to surround that transaction and that data with intelligence," he says.

"We'll see a range of these things: decision support; workflow engines, predictive algorithms; logic that looks at EHR data and cleans it up so it stays consistent; advanced diagnostic technology which takes in image, molecular medicine data and EHR data; intelligence that brings in stuff from your device to my device. At the service level it will be very similar to now, but deep in the interface it will be quite different."