Visualizing the Electronic Medical Practice of 2015

It’s no secret: physicians are reluctant to adopt electronic health records (EHRs) for a host of reasons. But as the financial incentives for EHR adoption begin to take effect – and the threat of financial penalties for not adopting them looms as 2015 approaches – it’s clear that doctors have little choice.

But rather than suffering through the transition, a less-painful and more-beneficial option is to visualize the various rewards and efficiencies that the fully automated medical practice of 2015 will offer.

Some benefits will come directly from EHRs – also known as electronic medical records (EMRs) – such as quicker billing and improved compliance with evidence-based medicine. But others will be EHR byproducts, as software with new functions hook into EHR data, or as health information exchanges expand in conjunction with EHR momentum.

A vision of these various benefits can begin with an automated call to patients reminding them of their appointments. The interactive software that makes the calls runs in conjunction with an office’s EHRs and practice-management software, allowing patients to cancel or reschedule doctor visits through automated prompts.

In response to two canceled appointments, the office clerk calls two waiting-list patients who are delighted to get in earlier to see the doctor – who has just saved a bundle.

“For every no-show, a practice loses $100,” notes Chandresh J. Shah, a marketing executive at software maker Waiting Room Solutions. “If I can fill a slot, I can manage my practice better.”

As a new patient arrives to see Dr. Smith, there is no need to hand him a clipboard to fill in his medical history. The patient’s previous physician has already transferred it into a health information exchange that Dr. Smith accesses and reviews on her tenth-generation iPad, as the patient is ushered in to the exam room.

The doctor docks her iPad and pulls up the patient’s latest blood-glucose results on the large examining-room monitor. With an EHR, says Shirley Garcia, a senior product manager at AdvancedMD Software, diabetic patients can better understand their “blood glucose records and can trend that over time.”

The two discuss techniques for getting post-meal readings under control, as Dr. Smith clicks diagnosis codes and double checks a list of items to review with the patient from the EHR's evidence-based medicine engine. They agree on several things the patient will do and the doctor taps the iPad to print the reminder list the patient can pick up at the front desk on his way out.

Some of the doctor’s recommendations are based on previous experience with other patients, as discovered after Dr. Smith runs a query on treatment data her EHR has culled from all the diabetics with a similar age and demographic to her current patient.

When the patient leaves, Dr. Smith tells the EHR software to send diagnostic and treatment codes to the billing team, who quickly submit an electronic claim to the insurance company. No more hunting for codes or down coding – time and money are saved.

“There is more accuracy in the charges being filed,” says Garcia. “All the codes are captured for the procedures performed.”

The doctor smiles remembering the significant drop she’s seen in requests for additional patient information from insurance companies and Centers for Medicare and Medicaid Services (CMS).

“There could be a hidden benefit with a smaller number of audits from the insurance companies,” says Shah. “A certain percentage of claims are always rejected, or the insurance company comes back to the doctor for more data.”

Dr. Smith’s next patient is experiencing leg swelling and needs to be referred urgently to a heart specialist. So she recommends the best cardiologist she knows from among the list her EHR says are in her patients’ network. The specialist is on the other side of the country but is available. Dr. Smith pulls up the patients record and invites the specialist, online, to review the EHR and suggest a treatment.

“Think of how much easier it will be to have a consultation with an expert,” notes AdvancedMD’s Garcia.

The next patient is a business executive in town for a conference but who is having trouble with her hypertension medication, and who has sent her records to Dr. Smith from her mobile phone. Dr. Smith suggests a medication change, but her EHR software flags a potential interaction with the patient’s estrogen therapy. A new medication is prescribed. Rather than putting her chicken scrawl to paper, Dr. Smith electronically transmits the new prescription directly to a pharmacy near the woman’s hotel.

To be sure, this visualization neglects some of the inevitable technical and workflow glitches along the way. But those glitches are likely to be nothing compared to the ultimate benefits EHRs will offer to doctors and patients.

“The concept that everything is accessible anywhere, anytime is amazing,” concludes Waiting Room Solutions’ Shah. “This is one of the biggest things you’ll see in 2015. That is going to be big.”

The thumbnail image was produced by Wenzday01.