Pre- Obama care, a medical practice management system (“PMS”) was used by physicians primarily as an office administration tool to capture patient demographic and billing information, schedule appointments, maintain lists of insurance payors, perform billing tasks and generate reports. Volume was a doctor’s friend as long as patients filled up the waiting room and produced their insurance card at the front desk. A determination of insurance eligibility and coverage by a dutiful staff member cleared a physician to do whatever he or she deemed to be in the best interests of the patient, with little to no financial risk.
The passing of the Affordable Care Act (“ACA”), which included the HITECH Act’s stimulus incenting physicians to adopt and make meaningful use of a certified electronic health record (“EHR”), led to the integration of an EHR with a PMS. This system integration enabled physicians to address both clinical and administrative needs of medical practices, and delivered to physicians the fundamental capability of seeing a patient from a financial and clinical perspective. Prior to the integration of a PMS with an EHR, the administration of a medical practice was a throwback to the “horses and buggy” era with manila folders and appointment reminders sent by the U.S mail.
The adoption of EHRs was tantamount to “paving over the cow path” in terms of its basic transformation of paper files to digital information management. The integration of a PMS with an EHR, which enabled clinical information access and exchange in tandem with patient administrative data, was the equivalent of building the healthcare information highways “on and off ramps”. Information could be received from and sent to an EHR creating a new standard for digital health information management. However, the ultimate objective of improving the cost and quality of healthcare for patients has not been solved by the integration of an EHR with a PMS, and will be dependent upon effective care coordination and collaboration between clinicians, their staff and patients armed with the digital information lying within their clinical and administrative systems of record, the EHR and PMS.
The transition from fee for service reimbursement of physicians to value-based payments, where quality and outcomes will increasingly take precedence over volumes of procedures and encounters, will demand that clinicians and administers regard their medical practices as patient communication and engagement hubs. While ACA provided the catalyst for the digitization of patient encounters and information exchange, outcomes-based healthcare will require medical practitioners to enable their administrative and clinical staff to function more like air traffic controllers than pedestrian cross walk attendants. The task of “clearing patients for satisfactory outcomes” will require information and communication technologies that resemble sophisticated air traffic control systems that manage and coordinate preflight, take-off, flight plan, and landing requirements for a myriad of aircraft representing multiple airlines with different flight plans. The capabilities required by clinicians to care for disparate patient populations representing a myriad of health conditions dependent upon adherence to multiple care plans delivered across different venues will require a hub and spoke network connecting primary care physicians with specialists, and acute care hospitals with post-acute facilitates. Patient “preflight requirements” in a value-based world will require having real time access to a patient’s longitudinal health record in addition to eligibility and enrollment data. Patient “takeoff” will require transparency about treatment alternatives, and cost and quality differentials. Patient “flight planning” will demand understanding of and compliance with care protocols, and a clinician’s ability to trigger the “fasten seat belt sign” in between physical encounters.
In a value-based world, a physician’s ultimate “landing requirement” for a patient will be a satisfactory outcome. Optimizing profitability of medical practices in a world of performance-based payments will require new and different “navigational systems” to guide patients on their healthcare journey. Providers must assume a role similar to air traffic controllers to ensure that patients are cleared for treatments that deliver value – an improved outcome at a lower cost.
The integration of a PMS with an EHR, which has allowed clinicians to interact with and report clinical and financial information as other than disparate, disconnected data sets, must be transformed into a “patient radar system” with new levels of connectivity, tracking, engagement, education and decision support likely beyond the core competency of legacy PMS and EHR vendors. Hence, the medical practice of the future will be reliant upon technologies that emerge from new forms of collaborations between legacy EHR and PMS vendors, and best of breed solution providers that deploy cloud based solutions that can easily integrate and seamlessly exchange information with existing systems.
In a value-based healthcare market, technology that sustains a network of interconnected clinicians that track and manage a patient’s health status, automate the development and distribution of care plans and monitor patient compliance with treatment protocols will be as common place as air traffic control systems. Clinicians and administrators will demand these capabilities in order to “clear patients for satisfactory outcomes” as they pursue their healthcare journey.