in HIPAA Headlines by John Brewer

A recent article on Health Data Management implied there is a “blind spot” in EHRs when it comes to ACOs.

What I thought would be a deep and informative article about the use of EHRs in ACOs ended up being not much more than a few more statements of the obvious and more improper terminology use.

Maybe I get too wound up in proper terminology use, but then again, I do so for a reason.

In the military, your days revolved around acronyms.  If you didn’t know them, you’d be left in the dust.

So, let me do some clarification before I talk, briefly, about this article…

EMR: electronic medical record – that electronic version of the paper folder your medical records used to be in.

EHR: electronic health record.  That “thing” that organizes all of the EMRs.  Many times EMR and EHR are used interchangeably, and though I don’t agree with it, I’m not going to get too hung up on this point.

PM: practice management (system).  This is that software that generally manages the scheduling and billing for a medical office.

Almost everywhere you look people refer to EHRs, when they may be talking about the PM.
An EHR generally can not show an ROI because it simply deals with managing the EMRs of each patient.  Yes, there may be some efficiencies of scale that come with this, but most private practices will not be able to show a monetary outcome of these efficiencies.

Also worth noting: Firing your transcriber is not ROI…there is not investment made in firing somebody.

A PM can show an ROI, as it deals with money and billing.

Very good, now back to the story…

The article notes an EHR is a prerequisite to an ACO.  Then goes on to say:

“The key to a successful ACO is being able to control overall costs for a population…and that includes keeping high-risk patients in network as much as possible, avoiding what payers call “leakage,” or using services outside the core group of contracted providers.”

If anyone thinks an EHR is going to handle this high level of complex patient management, they are kidding themselves.

Most EHRs are stressed to their limit to just store records and make the input/output process as efficient as possible (yes, I hear the laughter in the crowd with my use of EHR and efficient in the same sentence).

The point is, this level of data analysis is well beyond what one should expect from an EHR while it is completely reasonable to think there should be some 3rd party software that would be able to tap into your EHR, mine through all of your data, and ensure patient “leakage” is minimized and in network utilization is maximized.

I suppose the short version of what I’m saying is, if you are talking about EHRs, make sure you are really talking about what an EHR should/does do.

Also, we’ve heard recently that hospitals are using “fancy” software to maximize their billing to insurers which is actually increasing costs vs decreasing, which we’ve all been told would happen…there has been some backlash against this software.  I fully expect to see the same cycle occur in the ACO world.

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