The Electronic Health Record Foundation for Pharmaceutical Management

Abstract

As health systems are forced to shift from volume to value, with a focus on delivery of the Triple Aim, they are in search for tools. As a result, health systems, out of necessity, are becoming more integrated in terms of provider and payer responsibilities and control. This shift was demonstrated in a national survey we conducted of 27 executives from a wide range of health systems, which varied in terms of location, size, and level of integration. The respondents indicated that their level of integration will double over the next 10 years (Fig. 1). This means that health systems will be looking for tools to help them improve the health of their populations within increasingly integrated systems. One area of opportunity is in electronic health records (EHRs), which are becoming a common thread connecting the fragmented components of health systems. Beyond providing a connection, the EHR also can act as a lever that health system leadership can use to guide providers to their preferred treatments. The “right drug for the right patient” can be achieved within the EHR at the point of care based on patient demographics, comorbid conditions, laboratory and other diagnostic results, and history and physical findings. The importance of information technology (IT) investment was noted in another question in the same survey of health system executives that asked: “What are your organization's three biggest barriers to successfully deploying population health programs?” (Unpublished data; The Access Group Integrated Health System Survey; September 26, 2016). Of course, taking advantage of the EHR as a tool requires a clear appreciation of the opportunities and challenges that come along with it.

FIG. 1.

Integration of provider and payer responsibilities and control over time.

The EHR Foundation

Health systems have invested heavily in acquiring EHRs and other health technologies in the last decade. The adoption of EHRs has more than doubled since 2008.¹ Although incentive programs surely have contributed to the rapid rise in adoption of EHR systems, the evolving needs of health systems to adapt to the changing marketplace are not always reflected in the use and customization of EHR systems. Because it may take years for a health system to roll out a new EHR platform, many initially focus on addressing individual patient needs instead of optimizing the EHR to serve patient populations, which can become a never-ending cycle. Historically, EHRs were created to focus on managing individual patients. Evolving market needs slowly change EHR capabilities, such as managing avoidable hospital readmissions to prevent financial penalties.

More recently, new population management capabilities and suites have been provided to health systems by both EHR vendors and other technology suppliers. However, because of mergers and acquisition activity, a lack of regulations enforcing data transparency, and the reality of integrating disparate EHR systems and other technologies, the full capability of EHRs to manage patient populations has not been fully realized by health systems.

The health IT community and life sciences industry also have taken notice of the rise in EHR systems. Increasingly innovative health systems are turning to patient journeys, evidence-based guidelines and other insights to morph EHRs into solutions that not only document and manage individual patient care, but also are capable of offering population health solutions for all patients. Support has come from unexpected corners, with the life sciences industry being a prime example. Life sciences organizations have a long history of identifying latent patient populations (ie, patients not actively seeking routine clinical care) as well as the active patient population. Understanding motivational and behavioral patient factors has been an area of focus for life sciences organizations. Today, traditional life sciences levers such as promotional sales forces, formulary placement promotion, and direct-to-consumer advertising, all have declining returns. Given the life science industry's breadth of expertise in understanding patient journeys, persuasive patient messaging, and a potential interest in areas of mutual interest, new collaborations between health systems and life sciences organizations are developing and have been growing in numbers. Novel channels, such as the optimization of the EHR may provide a win-win for all parties involved —patients, health systems, and life sciences organizations.

Chronic Care Management

Most successful EHR-driven population management collaborations may be found in chronic condition management, but they also are growing in other domains such as oncology and specialty and acute care. The integration into the EHR of evidence-based pathways and guidelines aimed at minimizing practice variation is achievable today as stoic free-text documentation habits are slowly replaced with templated, structured documentation that opens the path to intelligent mining and predictive capabilities. Some of the most successful collaborations between health systems and life sciences organizations may be found when the EHR is leveraged to activate patients—both inactive patients who do not seek routine clinical care as well as patients who have regular clinical visits. Patient pursuit lists showing patients who meet predefined clinical and demographic criteria, the application of next-generation clinical decision support, and the integration of patient engagement solutions are seen as helpful by health systems as they expand their traditional digital population management options. Many of these novel approaches are workflow sensitive and offer flexibility in terms of workload.

Consider a therapeutic area such as dementia, for example. Delays in the early detection of symptoms and diagnosis may lead to earlier cognitive function loss. Because guidelines, assessment tools, and best practices are not always present in the EHR, it often results in clinical practice variation, a limiting factor in population management. Without supporting EHR tools, inactive patients who may be at risk for developing dementia related to family history and other known risk factors may be missed entirely. Integrating simple early assessment tools into the EHR, both self- and clinician-assessed, evidence-based guidelines in the form of disease-specific order sets and care plans, may reduce the need for clinical alerts (leading to alert fatigue) and improve the odds of early identification, diagnosis and treatment to preserve cognitive function. The exchange of ideas, insights, and resources between health systems and life sciences organizations may enhance the overall experience with the EHR solution while benefiting patients and population health.

Collaboration Between Health Systems and Life Science Companies Via EHRs

Successful collaborative efforts between health systems and life science organizations hinge on multiple factors, such as willingness, ability, and timing. As EHRs continue to evolve from documentation management solutions into patient and population management enhancement tools, the opportunity for health systems and life sciences organizations to work together and offer solutions aimed at achieving the Triple Aim is here to stay.

As health systems shift from volume to value, this onus is firmly planted in clinical and economic outcomes—assuring that providers follow recommended care paths is critical. Although the overall poor EHR user experience, burdensome documentation requirements, and evolving reimbursement model may add further burden to health systems, opportunities still exist to reduce complexity and create efficiencies while improving patient quality outcomes. Building these guidelines into the EHR is a tactic that can effectively change behavior in a positive direction without disrupting what is recommended and what is delivered.

Footnotes

Author Disclosure Statement

The authors declare that there are no conflicts of interest. The author did not receive financial support to conduct the study, write the manuscript, or otherwise assist in the development of the manuscript.

References

The Office of the National Coordinator for Health Information Technology.. Health IT Dashboard. Office-based physician electronic health record adoption. https://dashboard.healthit.gov/quickstats/pages/physician-ehr-adoption-trends.php Accessed May 23, 2017 .