EHR integration lessons learned

They never said navigating the electronic medical record landscape would be easy — at least not at first. And as new regulations from both federal and state spheres begin to tighten their hold around the industry, the valleys of EHR adoption and EHR mastery are sure to only become more congested and therein, even harder to get a handle on.  

Fortunately, current EHR veterans saw it coming and set out early with open minds — ready to note and reroute the process wherever necessary — and are now reporting back at last on the troubles and tricks that arise when dealing with digitized data.

Panelists on deck in Boston for the recent Health IT Summit session titled "EHR Data: A Touchstone for Quality Care" had plenty of diverging facets to share on the topic of EHR integration, but one primary point remained: We are all in this together.

“For things like this, I think all doctors are created equal,” said Jonathan Leviss, MD, chief medical officer for Rhode Island Quality Institute, a physician for Thundermist Health Center and a clinical assistant professor for Alpert Medical School and Brown University.

“The one thing that I’ve learned most importantly is that these are team-based efforts,” he continued. “We’re talking about getting data out of electronic health records, out of different HIT systems, to drive quality initiatives, which requires us to look at data in a way that an individual person can’t, the individual brain, whether that’s a physician, a nurse or a quality person.”

Beyond that need for a pack mentality in the EMR stratosphere, Reid Coleman, MD, chief medical information officer for evidence-based medicine, Nuance Communications, spoke of the importance of roles distributed to people who both know the importance of data and who want to be strictly involved in the pursuit of it.

“Unfortunately, we started to lean too far in one direction in turning clinicians into data-entry technicians, which clinicians don’t do well, which I think is important and they don’t like doing, which is equally important,” Coleman said. “One of the big challenges that we face is finding a way to let the clinicians do what they do best, which is tell the patient’s story and explain their understanding of both the patient condition and plans for treatment and then use tools to take that and turn it into usable data. And boy, do we need the data — we need the data for analytics and from my perspective, to trigger workflows, to set people down the right path based on what the clinician has said about the patient.”

Leviss elaborated on the necessity of arranging the right players where they can be the most useful.

“The reality is there are technical challenges to these, there are human-payer incentive related challenges to these and there are physician challenges and I think the one thing that I’ve learned over the last years work on these is that what we have to keep in mind first, that we need to understand the pieces, the complexities and how we assemble the right team,” Leviss said.

From a payer perspective, it’s important that data technicians be able to couple information in a way that is not only palatable to clinicians, but also those who compose the claims department.

“I think you can use data, but connecting the EMR to the claims data actually helps the payer understand the practice patterns, the best practice guidelines and also probably, from an analytics standpoint, it is important to us [payers] in how we are driving behaviors,” said Rajni Aneja, MD, MBA, strategic executive and clinical transformation leader, Humana. “Because ultimately, even if you practice medicine in clinic or outpatient settings or hospital settings, the behavior change is happening at many different levels and connecting all these dots through data and driving those outcomes are very important.“

The concept of using data to mark behaviors while also diametrically keeping a keen, understanding eye on other realms is also important for practice managers to consider, according to Thomas D. Sequist, MD, MPH, director of research at Atrius Health, associate physician at Brigham and Women's Hospital, and associate professor of medicine, Harvard Medical School.

“When I think about the EHR data, I think about it in two spaces,” Sequist concluded. “I think about it in terms of what we’re going to do with the data and about whether you need it in real time to drive real-time decision support or behavior change for the clinicians or the staff or whether you’re using the data for population management between office visit care and what you’re going to be trying to accomplish with those motives. And I find that how the data’s structured, how the data’s entered, how you collect it, is pretty different depending on those two motivations.”