If we’re truly moving closer to a value-based model—and I think most healthcare leaders would agree that we are—then we, as providers, must become laser focused on what’s best for our patients. For a long time, we resisted the call to adopt technology in our practices for that very reason—and some of us still are. But, the software we use doesn’t have to be a barrier to patient care. In fact, the bond between technology and optimal care is growing stronger by the day.
However, while widespread adoption of electronic health records (EHR) and electronic medical records (EMR) systems—aided in part by policies like the Health Information Technology for Economic and Clinical Health (HITECH) Act—has positively impacted the American healthcare system in many ways, I believe such legislation has also caused many providers to rush into implementing software that doesn’t totally fit their needs.
Specifically, many organizations—large and small alike—have adopted one-size-fits-all solutions that don’t provide much in the way of workflow and data-collection customization. Large hospital systems benefit from these behemoth EHRs, as they have multiple pieces of technology that must integrate seamlessly. I’m talking major billing and administrative functions, radiology and imaging systems, and admission and registration programs. Private practices, on the other hand, have far different workflows—and they don’t need all those bells and whistles. And because these generic, run-of-the-mill systems require niche providers—including PTs, OTs, and SLPs—to conform their documentation workflows to physician-based templates, the data these systems collect doesn’t adequately represent the type and quality of care that we, as specialty providers, deliver. Furthermore, their lack of efficiency and adaptability are incredibly frustrating. Now, historically, rehab therapists and other specialists who partnered with large hospital networks didn’t have much of a choice. But, I foresee that changing. After all, as one of my fellow 2017 Graham Sessions attendees noted, “Systems are built for a certain point in time’s need, and sometimes those systems have to change when the demand changes.”
Over the years, with tech advances in interoperability, larger hospital systems have adopted some speciality-specific EMRs—thus creating greater care and workflow efficiencies. But, because physical, occupational, and speech therapists are seen as ancillary players in health care, our needs often are considered lower priority; after all, we’re still trying to prove our value on the overall healthcare stage. And despite the fact that empowering specialty providers to use niche platforms would align with the triple aim—and potentially enable hospitals to better manage treatment at the episodic level—larger EHR systems have been reluctant to integrate with other EMR/EHR specialty systems.
Why is that? One of the main reasons is, quite simply, that hospitals are busy. Meaningful Use upgrades, large-scale EHR implementations, and continual employee training efforts in large healthcare systems aren’t easy endeavors—and in the grand scheme of things, EHR adoption, thanks in part to government incentives, has been very fast. Plus, the requirement that systems actually “talk” to each other is also very new. Data collection has been ongoing, but as we’ve discussed in previous posts, the emphasis on analyzing that data for meaning is just now starting to take shape.
With the absence of outcomes data, today’s hospital systems measure value solely based on utilization (i.e., the number of visits it takes for patients to make a full recovery), which is ludicrous. Instead, they should be focusing on delivering better quality care at a lower cost—that is the true definition of value, after all—which means they should be consistently collecting and tracking outcomes data across the entire organization. But, that’s easier said than done, especially because, traditionally, EMRs are built primarily for documentation and billing.
I could argue that phase one of the HITECH Act strategy was full-scale EMR and EHR implementation, while phase two is all about integrating digital platforms—in other words, getting the systems to talk and share information with each other—to create true interoperability. And that’s where we are today—which means we have the opportunity to connect these disparate systems, thus enabling providers across the entire continuum of care to make more objective decisions about patient treatment. Specialty EMRs aren’t designed to work in isolation; rather, they function at their full potential when they’re sharing and combining information from all different sources. And providers of all stripes should get on board that idea. After all, with healthcare moving to a more patient-centered model for care, collaboration will be critical to success. In the words of another Graham Sessions attendee, “Collaborate or die.”
However, all-encompassing EMR integration among hospitals, transitional care facilities, and outpatient clinics remains an elusive challenge—but it’s one we must overcome. Now, some of today’s niche EMR players—like WebPT—are looking for ways to make integration a more seamless process. But, they’ve run into resistance from the bigger EHR vendors—mainly because those companies are busy with larger hospital-to-hospital integrations. Plus, for hospital administrators, niche EMR systems represent an expense that has yet to show any potential for return (e.g., improved care quality and better patient and provider satisfaction). Still, the hospital landscape—like the overall healthcare landscape—is changing. One Graham Sessions speaker summed up this transformation perfectly: “The hospital of tomorrow is going to look markedly different than the hospital of today—and that’s our opportunity.” And for hospital organizations looking to make long-term strategic decisions versus short-term cost-saving measures, the juice can be worth the squeeze. For example, organizations that embrace a collaborative care model understand the need for specialty systems. As such, they are investing in integrative digital platforms, where multiple systems can receive and exchange patient data and information seamlessly.
Speaking of long-term savings: We, as rehab therapists, cannot truly own our roles as the premier neuromusculoskeletal experts of the healthcare community—and stand up for ourselves as a profession—if we cannot consistently and definitively show our value on a bigger scale. As another Graham Sessions attendee noted, “Physical therapy is the best-kept secret in health care.” But, our value shouldn’t be a secret—and that’s where the outcomes data tracking piece will really make a difference. With this data in hand, we can more confidently assert ourselves as low-cost, high-touch providers. Early intervention also plays a big role in avoiding massive downstream costs (e.g., surgery and expensive medications) and improving overall quality of care. But, we can’t advance the needle on those fronts—and finally be recognized as major health care players—if we continue to sit back and succumb to what hospital administrators decide for us as an industry. By raising our collective voices, we can demonstrate how EMR and data-tracking software built specifically for our clinical needs can help our partners in the hospital space save money and improve care quality.
Frankly, I’m fired up to see what’s on the horizon for rehab therapists on this front, because if we work diligently and play our cards right, I know we have it in us to disrupt the healthcare technology landscape—and the traditional care trajectory—as we know it. Ultimately, creating full-scale EMR integration between hospital and post-acute care providers alike will enable the entire healthcare system to improve care quality, better manage health populations, and reduce wasteful spending. In the words of The Carpenters, “We’ve only just begun.”