Learn how to leverage technology so you can make better clinical decisions for your patients.
Healthcare is rapidly changing thanks to value-based reimbursement, expensive medications and therapies, a focus on patient experience and increasing administrative burdens. Physicians, therefore, have no choice but to continuously adapt and evolve to remain true to the purpose of helping and healing patients. Technology plays a critical role in this evolution, and EHRs have to balance the need to continuously add new tools that enhance physicians’ decision-making and meet requirements to add more features that support regulatory and administrative processes.
Embracing new technologies, whether to streamline or improve clinical care, can be time-consuming, require workflow changes and even add time to a patient visit to fully realize the benefits. But that investment of time and energy can help physicians work smarter - eliminating rework, making decisions with complete patient information and streamlining communications with other caregivers - by taking advantage of tools that already exist in many EHRs.
Here are five places physicians can start:
With the growing dichotomy between cheap, generic medications and incredibly expensive biologics or other new brand-name drugs, the cost of medications cannot be ignored during physicians’ decision-making process. The easiest path for physicians is to simply focus on the clinical aspects when choosing a medication. But when cost is not considered during the prescribing process, patients are often surprised by the cost at the pharmacy. That could lead to medication noncompliance and the need to revisit patients’ records later with calls from the pharmacy to ask for medication changes.
Many EHRs support prescription price transparency, whereby physicians can see patients’ specific out-of-pocket cost and potential lower cost alternatives during the prescribing process. Importantly, EHRs have made it easy to review the options and choose a less expensive therapy (or an alternative therapy that does not require a prior authorization) before completing the prescribing process.
Reviewing the economic information about medications may add time to an already short office visit, but it can improve medication compliance and the overall patient experience while preventing phone calls, rework and prior authorizations. Physicians often have a sense of which classes of drugs are expensive; by seeing patients’ specific out-of-pocket cost information and potential alternatives during the prescribing process, physicians can potentially save patients hundreds or even thousands of dollars per year while achieving the same clinical outcomes.
Talk is not cheap in healthcare. Taking the time to discuss a patient’s care with other physicians comes at the cost of potentially seeing more patients or leaving the office earlier. In the past, the only options were phone calls, letters, face-to-face discussions or faxes.
Today, there are a host of new communication methods that can eliminate time-consuming communication, including intra-practice communications within an EHR, inter-practice communications withdirect messaging
in the EHR, secure email and secure text messaging. These have increased the ease of sharing patient data and speed of communications. But they come at the cost of additional information for physicians to digest and assimilate, which can quickly become overwhelming.
Fortunately, direct messaging has a unique advantage because the message is transmitted securely, is incorporated into the workflow of the EHR, works across different vendors of EHRs and can include attachments with clinical information from the chart. Together, these capabilities are especially valuable to replace faxing and letters in areas such as referrals. In addition, physicians can define processes to triage incoming direct message communications with office staff and create fail-safe models to ensure critical communications are acted on in a timely manner.
Prior to EHRs, it was common to make critical decisions in a vacuum. Physicians, especially those on call or when admitting a patient in the hospital, would not have access to paper charts or historical data from outside sources.
Today, not only is information readily available in the EHR but patient information from care settings across the country can be instantly retrieved via national interoperability frameworks. Patients benefit by not having tests repeated and by knowing their physicians are making care choices based on a comprehensive review of their records. For most physicians, the knowledge of making a fully informed decision can outweigh the time investment to review additional records, especially in complex situations. As technology progresses, EHRs will continue to advance, allowing physicians to quickly locate the most crucial elements of their patients’ past history to support rapid clinical decision making.
One of the most time-consuming elements in patient care is trying to maintain an up-to-date, accurate medication list, especially when patients are seeing multiple caregivers and filling medications at multiple pharmacies.
In the past, patients’ medication lists were only as good as their recollection or which pill bottles they brought in. Physicians and pharmacies maintained their own medication list, largely without communicating with each other.
Today, most EHRs support the ability to automatically populate a medication list by retrieving dispensing history from pharmacies and pharmacy benefit managers. While this adds a new task of reconciling the imported data with patients to ensure accuracy, the medication history can largely eliminate the need to manually input each individual medication, resulting in a more complete, accurate medication list.
In addition, new e-prescribing transaction types can send a cancellation message to pharmacies when a medication is discontinued in the EHR that notifies pharmacies to stop automated renewal and refill processes going to both the physician office and the patients. While these tools require an investment of time and workflow changes to adapt the intake and reconciliation processes, the time saved by auto-populating the medication list and the added patient safety benefits of preventing inadvertent refills for discontinued medications outweigh the initial time investment.
Prior to the opioid crisis, writing a prescription for a controlled substance required a couple of extra steps compared to a regular prescription, such as writing out the quantity in words and adding your Drug Enforcement Agency (DEA) number to the prescription.
Today, with the increased risk and sophistication of forged or altered prescriptions to obtain illicit narcotics, it is incumbent upon all physicians to take every step possible to prevent fraud and drug diversion. Virtually all EHRs and pharmacies today allow for electronic prescribing of controlled substances, which requires an additional authorization step during the prescribing process, such as clicking on a notification on your phone. Electronic prescribing of controlled substances will be required for all Medicare Part D patients effective Jan. 1, 2021, and many states are adding similar laws requiring electronic prescribing of controlled substances for all patients.
The simpler days of medicine are behind us. EHRs have added a multitude of new features to review clinical information, collaborate with other caregivers and staff, and support better clinical and economic decisions for patients. Additional administrative burdens have required EHRs to incorporate more capabilities and complexity. Together, those many features sometimes makes physicians miss the halcyon days of paper charts, paper prescriptions, phone calls and letters.
EHRs, though, can help physicians work smarter - preventing rework and extra work by being fully informed on clinical and economic factors when making therapeutic decisions for patients, automatically incorporating medication histories into the chart, eliminating faxes for physician to physician communications with patient records, and preventing renewal requests from pharmacies for already discontinued medications.
Andrew Mellin, MD, MBA, is the vice president of medical informatics at Surescripts, where he helps the Surescripts Network Alliance improve the care experience for both physicians and patients with a focus on technology and smart workflow solutions. Mellin has more than 20 years of experience in health information technology, patient quality and safety, consumer health and EHR implementation and adoption. Mellin is Board Certified in internal medicine and worked as a part-time hospitalist in St. Paul, Minn., for 15 years.