Computer laptop, stethoscope and clipboard with blank paper sheet on the table

For a technology created with the intent to improve quality of care and efficiency, electronic health records (EHRs) have yet to find widespread approval among physicians, who blame them for lost productivity and more time in front of a computer. A 2014 survey conducted by the AMA and AmericanEHR Partners found that just 34% of physicians said they were satisfied or very satisfied with their EHR, also known as electronic medical records (EMRs). Former Acting Administrator of the CMS, Andy Slavitt, recently stated that most EHRs are basically “filling out a billing record instead of something that is helpful and intuitive to a doctor and a patient.”

The frustration is unfortunate because the purpose of EHRs is to document care, as well as eliminate the mistakes and time wasted associated with paper records. Electronic records are supposed to allow doctors to diagnose problems faster and spend more time with patients, not make it more difficult.

Luckily, I’ve had a more positive experience with the EHR used at the health centers for which I work. The EHR supports all aspects of the care process—from primary care and health assessments to care documentation and clinical decision support. It is a critical component of our healthcare delivery.

In my opinion, the problems other physicians face are due to the wide variety of EHRs available, and the fact that there is no standardization for sharing EHR data with other providers. From the advent of regional health information organizations (RHIOs) to the current attempts to form health information exchanges (HIEs), healthcare IT vendors, in general, remain divided on what data fields should be exchanged. Demographic and billing information can be shared along with diagnosis and coding information, but lack of uniform storage parameters prevents any universal integration in a standard format.

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Four criteria for evaluating EHR effectiveness

Despite the problems some have with EHRs, they are here to stay. Providers will have a much better experience using EHRs that are optimized for both them and their patients. Because there are so many options to consider, I look at several key areas to evaluate an EHR’s effectiveness. According to this criteria, an effective EHR should:

  1. Support population health management. This is the most critical element for an effective EHR. Everything else will revolve around it. The EHR should also include embedded and current real-time evidence-based clinical guideline tools for chronic conditions that are triggered in complex cases when the provider has entered the clinical note. For example, some EHRs link symptoms and conditions with a medical knowledge base for evidence-based guidance in real-time, at the point of care.
  1. Incorporate claims data to determine when tests have been performed or vaccines administered. An EHR cannot be effective for providers if it cannot accept and analyze claims data. One of the benefits of the EHR we use is that we are able to get information about the Standard of Care from claims data that gets imported into the EHR. It allows me to generate a report on all of my diabetic patients who are not at the Standard of Care so I can conduct outreach to them. The EHR uses built-in Standard of Care guidelines for a wide array of chronic conditions to match the care protocols for that condition against the evidence in the claims data. This provides the medical staff with information on care gaps, reducing unnecessary risks caused by patients not getting the care they need when they need it.
  1. Include a patient wellness score that provides a quick snapshot of the most at-risk patients. For example, my EHR uses a 100-point risk quantification methodology to stratify the health center’s population and provide each participant with a “Wellness Scorecard.” The scorecard provides personalized wellness initiatives and instructions, health improvement plans, as well as fitness and nutrition trackers. This is an important aspect of maintaining sustainable health improvement: Giving patients access to the education they need to make lifestyle changes.
  1. Incorporate a patient portal so providers can electronically communicate with patients. With a personal health record (PHR), both provider and patient can organize and store the patient’s health information, including test results, treatment and management plans, health history, clinical notes, claims data, and biometric data. EHRs and PHRs allow for real-time interactions between patients and providers like we’ve never seen before. We’ve broken down barriers to communication, and now patients can ask me for test results as easily as they can fire off a text message. And as a family doctor, I appreciate that an entire family can be linked in an EHR. I can be in one family member’s chart and with just one click, I can enter into any other family member’s chart without having to use the typical “patient search” engine or type in any names, birthdates, etc.

If skeptical providers and health systems utilize EHRs with the above functionality, they will undoubtedly have a better experience and understand that they can be effective tools. With the right features, EHRs achieve their purpose of enhancing the coordination of care, eliminating fragmentation in delivery, improving patient health, and saving lives.

Sasha Loffredo, MD
Alexandra “Sasha” Loffredo, MD, is a family physician and clinical leader at Marathon Health. Prior to joining Marathon Health, Dr. Loffredo spent nearly a decade on faculty at the University of Texas Health Science Center in San Antonio, educating residents and medical students and taking care of patients of all ages. She received her medical degree from the University of Vermont and completed her residency training in Family Medicine at the Hunterdon Medical Center in New Jersey. Outside of work, Sasha enjoys time with her family, including her high-school-aged daughter, her husband, who flies for Southwest Airlines, and her four dogs. Her family enjoys skiing, camping, and traveling the world.

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