Adopting EMR and abiding by the concept of “meaningful use” of Electronic Medical records has its benefits because the American Recovery and Reinvestment Act created funding and incentives for healthcare professionals who adopted the system. However, starting in 2015, penalties are likely to be imposed on entities dealing with patient healthcare data that have not yet upgraded to electronic medical record technologies. EMR or electronic medical records will see an increase in adoption by physicians, healthcare organizations and their related business associates. A major challenge is the ability to take feeds in many different data formats and merge the data into business intelligence analytic tools. For example, a member can have services provided by physicians, labs, pharmacy, hospitals, mental health provider and others, but even if care is being delivered by an accountable care organization (“ACO”), the data will be fragmented.  In order for the data to be useful it needs to be normalized and then populated in a  patient-centric database. 

The solution is a workflow system that can normalize and track all incoming data to a plan member. Everyday new analytic tools emerge that can take the patient-centric EMR data and apply algorithms that look for errors and omissions in care, contra-drug interactions, prescription drug compliance, age-triggered tests or examinations, and the list goes on.  The only real solution for connecting all of this data to a patient is to have a robust workflow management system that acts as the traffic-cop and delivers the data to the right source at the right time.

Patient-centric data needs to reside on a workflow framework that allows the health plan to work collaboratively with the providers to improve quality of care and safety for the member, and allow information to be exchanged back to the provider in time to help.  There are a number of data elements that have to be present to accomplish this, and they are available today.  To begin with, when a health plan receives data, a workflow tool needs to first identify that the data belongs to an actual plan member.  One way to eliminate misdirected data is to have a robust eligibility system that interacts with the workflow framework.  There also needs to be a provider validation tool, again interacting through the workflow framework, which identifies the most current provider information.  The workflow management tool must also have the ability to log the intake and delivery of data, and track that the discovered outcome was acted on.  There are many care management tools that are being used in the health plan industry today.  Allowing care management providers access to workflow management systems that can access claim, eligibility and provider data, allows them to react to changes in care almost in real time.

Federal legislation promoting EMR is based on the principle that electronic records provide the combined benefit of securing patient information and cutting down healthcare costs. It should be noted that the proposed penalty in 2015 is of 1% and this is likely to increase incrementally, up to 5% in the following years. Most of the penalties will be levied in the form of reduced Medicare and Medicaid reimbursements. The financial incentive for a health plan that uses the right workflow management tool, populating and then using the data into EMR, will not only result in penalty avoidance, but the delivery of more informed member care.