You’ve heard the expression about putting lipstick on a pig, right? You could do it, sure—but it doesn’t change the fact that it’s still a pig. In other words, you can’t make superficial changes to something and expect those changes to alter the true nature of whatever it is you’re trying to dress up. This holds true whether we’re talking about a political candidate’s campaign strategy or, as is the case in this post, a product—like an electronic medical record (or health) system. Superficial upgrades to the EMRs and EHRs that were built to accommodate a fee-for-service healthcare paradigm aren’t going to be enough to level those systems up to this new pay-for-quality environment. (Some might argue that many of these systems don’t actually meet providers’ fee-for-service needs, either. But, I digress.) It’s going to take more than a little lipstick to make these already-outdated systems anything more than relics of a bygone era. Here’s why:

The State of Rehab Therapy in 2019 Guide - Regular BannerThe State of Rehab Therapy in 2019 Guide - Small Banner

As it stands, healthcare data isn’t being used to inform clinical decision-making.

According to Apixio CTO John Schneider—the author of this HealthData Management article—the US healthcare system produces 1.2 billion clinical documents each year. That’s billion—with a “B.” Unfortunately, ”the data in those documents is not used as fodder for more informed clinical decision-making.” That’s because the health IT that’s been supporting our fee-for-service payment model has really been nothing more than “an adjudicated claims stream to state what services were provided that required payment.” In other words, the systems aren’t equipped to help providers use data or data analytics to better understand—and improve upon—their care.

Most EHRs are products of the payment environment in which they were built.

While undoubtedly frustrating, this is not all that surprising given the history of technology adoption in the healthcare industry. As Schneider points out, less than a decade ago, most providers were documenting on paper. Then, in 2009, the HITECH Act offered providers some incentive to make the transition to electronic documentation—which increased the number of providers and organizations using EMRs/EHRs. However, the tools available at the time were mostly “point-of-sales systems whose purpose was to facilitate the business side of healthcare.”

While the Meaningful Use (MU) rules were developed to foster, well, meaningful technology use, there’s been a lot of controversy about their merit and effectiveness. According to Schneider, much of the backlash has occurred because these EHRs weren’t designed or developed with collaborative care or value-based payment models in mind. Rather, they’re products of the environment in which they were built: “At their core, EHRs were architected in a fee-for-service environment to improve clinician workflows and optimize billing,” Schneider said. “To accomplish that goal, they don’t require complete knowledge of patients. However, in a value-based environment, complete knowledge of a patient's health is critical.” Ruh roh.

Our new IT-enabled industry is having a hard time catching up.

Today, 95% of all hospitals and 75% of all physicians are using an electronic documentation platform. However, many of them aren’t thrilled about it. In his article, Schneider includes the results of a study conducted by the Mayo Clinic and the American Medical Association: While just under 60% of the physicians surveyed believe EHRs improve patient care, a little more than 60% reported that EHRs don’t improve operational efficiency. In other words, providers are forced to use software that they they believe “only impose[s] social and time costs without markedly improving care.” According to Schneider, “the healthcare industry is struggling to come to grips with the fact that it’s no longer a people-and-paper enabled industry, but rather a people-and-information technology enabled industry.” And the current IT-enabled industry is lagging behind: “the technology and tools haven’t had time to accommodate to the richness of clinical data,” Schneider said. Case in point: “80% of the data in EHR clinical records is unstructured and thus difficult to access outside of the clinical setting for which the EHR systems were developed.” (Looks like PTs aren’t the only providers struggling to amass meaningful data that can be understood outside of their own arena.)

But everything else in health care keeps moving forward.

As I discussed in this post, the MU program—at least in the form in which we’ve come to know it—will be replaced by the Medicare Access and Chip Reauthorization Act (MACRA), which is the umbrella program for the Merit-based Incentive Payment System (MIPS). Whereas MU required all eligible professionals to use an EHR that was Meaningful-Use certified, MIPS is taking the focus off of the technology itself and placing it on the outcomes clinicians are able to achieve through the use of technology. While this certainly seems like an improvement, it doesn’t address the real problem: “The recently proposed rules have made significant progress toward making the new framework less rigid and more valuable,” Schneider wrote. However, “the issue remains that we will be adapting systems that are designed for a pay-per-service model rather than an actual model of a patient’s state.”

In order for healthcare IT to evolve, we must prioritize data.

As a result, he says that EHR systems must “walk a fine line,” meaning that “if EHRs stray too far from the status quo of supplying the claims streams that have been the financial lifeblood for healthcare organizations, then provider organizations that use them have a problem.” When push comes to shove, financial and management features seem to trump data capabilities—but that’s not sustainable, because healthcare IT will only evolve in the way we need it to if providers and technology vendors start prioritizing data, too. So, how does the industry as a whole go about making this shift? Based on Schneider's advice, here are the two most important changes that need to take place in order for IT to be effective in this new healthcare paradigm:

  1. Providers must change their expectations about what an EMR/EHR can and should do; and
  2. Developers need to create systems that address the administrative and clinical needs of the providers who use them.

For developers to create these systems, though, providers need to start asking for—nay, demanding—them. (This further underscores the importance of nixing generalist systems in favor of specialty ones.) According to Schneider, “the ability to combine data from EHRs with clinical data from...notes, insurance claim data, pharmacy data, laboratory tests, [and] patients themselves...will lead to better care outcomes.” This type of a system—one that “combines both clinical and transactional data”—will enable providers to “understand patterns to improve care” and receive incentives for doing so.


What do you think about the current state of healthcare technology? Is the healthcare IT industry putting lipstick on a pig—or do you feel EMR and EHR companies are making real progress toward the goal of meeting providers’ needs in this new pay-for-performance era? Tell us your thoughts in the comment section below.

  • Cloudy with a Chance of Reform: 5 Key Healthcare Forecasts for 2017 Image

    webinarJan 5, 2017

    Cloudy with a Chance of Reform: 5 Key Healthcare Forecasts for 2017

    Predicting the weather is tough—just ask any meteorologist who has called for sun on the day of a major downpour. Well, predicting the fate of the US healthcare system isn’t much easier—there’s a lot up in the air, after all. But, even without a healthcare equivalent of Doppler Radar, there are a few key trends that are sure to have a major impact on PTs, OTs, and SLPs in 2017 and beyond. And to keep your practice …

  • Common Questions from our Cloudy with a Chance of Reform Webinar Image

    articleFeb 13, 2017 | 13 min. read

    Common Questions from our Cloudy with a Chance of Reform Webinar

    In our first webinar of 2017 , WebPT’s co-founder and president, Heidi Jannenga, teamed up with CEO Nancy Ham to discuss the current and future healthcare trends that will impact PTs, OTs, and SLPs. (Missed it? No worries; you can view the complete recording here .) As always, we received quite a few questions during the presentation—way more than we could address live. So, we’ve put them all here, in one handy Q&A doc. Scroll through and …

  • Breaking News: 2017 MACRA Final Rule Hits Image

    articleOct 17, 2016 | 4 min. read

    Breaking News: 2017 MACRA Final Rule Hits

    After months of heated debate and public commentary—much of it coming from physicians who felt they needed more time to prepare themselves to participate in a brand-new quality reporting program—the Department of Health & Human Services (HHS) on Friday released its final rule on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) . This act, which will go into effect January 1, 2017, reimburses eligible Medicare physicians based on the quality of care they deliver …

  • Founder Letter: PQRS is Dead, But Your Data-Analysis Efforts Should Live On Image

    articleDec 6, 2016 | 6 min. read

    Founder Letter: PQRS is Dead, But Your Data-Analysis Efforts Should Live On

    If there’s one thing I know about rehab therapists, it’s that we are all very busy people. If your to-do list is anything like mine, it’s growing faster than you can prune it—and has probably expanded onto multiple sheets of paper (or maybe even into multiple notebooks). And regardless of the value associated with each item on the docket, we tend to refer to these tasks as things we “have” to do—not things we “get” to do. …

  • CPT Update: Why the Valuation of the New PT and OT Eval Codes is Problematic Image

    articleJul 19, 2016 | 9 min. read

    CPT Update: Why the Valuation of the New PT and OT Eval Codes is Problematic

    The purpose of any type of reform is to drive change. And that’s certainly true when it comes to healthcare—and healthcare payment—reform. But, change often comes slowly—and in the wake of Medicare’s recently issued proposed physician fee schedule for 2017 , I have to wonder whether it’ll come too slowly for physical and occupational therapists. That’s because, while the Centers for Medicare & Medicaid Services (CMS) voiced its support for replacing the existing CPT codes for physical …

  • What the New HCAHPS Proposal Means for the Future of Hospital-Based PT  Image

    articleAug 11, 2016 | 3 min. read

    What the New HCAHPS Proposal Means for the Future of Hospital-Based PT

    When a patient is in pain, that patient wants relief—fast. And even if the patient knows medication is only a temporary fix—and a potentially dangerous one, at that—he or she will probably still choose drugs over longer-lasting, less-instant treatment options like physical therapy. For healthcare providers beholden to payment structures that incentivize patient satisfaction, that preference presents a real pickle: give the patient what he or she wants—long-term consequences be damned—or risk lower satisfaction scores (and potentially …

  • The Bundle Conundrum: Should PTs Participate in CJR? Image

    articleNov 9, 2016 | 6 min. read

    The Bundle Conundrum: Should PTs Participate in CJR?

    There a lot of hot topics in health care right now. Among top trending terms like “Affordable Care Act,” “pay-for-performance,” and “value-based care,” you’ve also probably heard “Medicare bundled payments”—specifically, “CJR” (or Comprehensive Care for Joint Replacement ). It’s a new bundled payment model from CMS, and it is of particular importance to outpatient rehab providers. As this article explains, “CJR will support better care for patients who are undergoing elective hip and knee replacement surgeries—the two …

  • Odd Provider Out: Why PT Exclusion from MIPS is Bad for Future Payments Image

    articleMay 4, 2016 | 6 min. read

    Odd Provider Out: Why PT Exclusion from MIPS is Bad for Future Payments

    It’s official: rehab therapists are just a sashay away from exiting the PQRS dance floor. That’s because last week, the Centers for Medicare & Medicaid Services (CMS) issued a proposed final rule that, if adopted, will put into effect the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA). And that, in turn, will give the green light to the Merit-based Incentive Payment System (MIPS) , a brand spankin’-new quality data reporting program that consolidates PQRS , …

  • What the End of Meaningful Use Means for the Future of Physical Therapy Technology Image

    articleAug 3, 2016 | 5 min. read

    What the End of Meaningful Use Means for the Future of Physical Therapy Technology

    Oh, Meaningful Use (MU), you’ve run your course. That was fast. According to the Journal of the American Health Information Management Association (AHIMA), last October, CMS announced the third stage of the Meaningful Use guidelines. But only three months later, CMS’s acting administrator, Andy Slavitt, announced the end of the program as we know it: “The Meaningful Use program as it has existed will now be effectively over and replaced with something better,” he said to a …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.