By David Lareau

By necessity, the healthcare industry will soon adopt a new way of thinking about electronic health records (EHRs), and a handful of influences are aligning to drive this evolution. The new reality is that EHRs, rather than merely supporting the coding of billable transactions, must provide tools to manage a patient’s health, preferably at the point of need, and involve all resources in the community who participate in the care of a patient––the “community of care.”

Consider the following influences and their pending impact on EHR functionality:

1. 21st Century Cures Act & TEFCA
The 21st Century Cures Act mandates that eight categories of clinical notes must be immediately available to patients. The Trusted Exchange Framework and Common Agreement (TEFCA) provides a framework for sharing of medical information. Both programs require compliance, and non-compliance penalties can range from a monetary fine to suspension from Centers for Medicare and Medicaid Services (CMS) programs.

2. Pervasive adoption of FHIR as a method for exchange of medical information
The Fast Health Interoperability Resource (FHIR) provides a mechanism for transmission and receipt of medical information that is now widely used as the “container” to package and send clinical data between systems and enterprises. Once this data is shared between disparate systems (including EHRs), clinicians must be able to locate and use the information they need when caring for a patient.

3. Software as a service (SaaS) and API-based interoperability
The demands for enhanced functionality and the need to comply with new requirements continue to grow. In response, the industry is producing more solutions to address specific needs such as quality measure compliance, and documentation and management of hallmark indicators for chronic conditions. This trend is accelerated by the “opening up” of existing systems to provide API-based interoperability––accessed in the cloud and available without extensive modification of existing systems. The exponential growth of offerings in vendors’ app portfolios is one example of this trend. One of the biggest resulting challenges will be to enable healthcare providers to readily find what they need when treating a specific patient.

4. Value-based care, particularly Medicare Advantage (MA) and similar programs
At its current rate of growth, MA is on track to reach 69 percent of the Medicare population by the end of 2030. CMS has set a goal to have 80% (or more) of Medicare patients on managed care plans by 2030. The aging population, including those with chronic conditions who are living longer, requires a new set of tools to identify those patients and to effectively manage, evaluate, assess, and treat their conditions. MA uses risk-adjusted reimbursement. The industry’s current focus appears to be on identifying those conditions that provide for higher reimbursement. The challenge will be better managing chronic conditions to reduce costs––not just to account, or record a code, for it. Healthcare information systems can no longer be primarily focused on accounting and billing, they must become clinical management platforms that support all individuals who provide care.

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