he challenge of enabling EHR interoperability is at the forefront of many conversations about EHR adoption and health information exchange (HIE). It’s the all-too-common features and benefits presentation for the use of health resources in the clinic.
For the independent physician, this interoperability is really part of a much larger dialogue about the continuity of the clinic as a business in this new era of highly integrated and accountable care. While it may seem like another vendor relationship conversation for the clinic advocate, it’s really about the value proposition for the patients in the community of care going forward.
There are three terms that should be drivers for the EHR/clinic dialogue but too often remain an afterthought: patient retention, care pathways, and EHR as an enabler.
Engaging people in a new conversation about healthcare is a challenging one, whether it’s on the path to accountable care or an informal approach based on those coveted referral relationships within a community. But it’s the interoperability of people that is so important in delivering an improved new patient experience that represents an ongoing journey, not just a hospital stay.
Patient retention is off to a bad start when you consider it follows the word “discharge.” In a conversation yesterday, I actually heard the term “patient leakage” used instead of retention. The starting point for how to retain patients in the clinic would be better served by posing the question, “What interactions do we expect?” For patients who have come to expect to wait at least 45 minutes in reception for a three-minute conversation in the exam room, the first obstacle for retaining their attention may have nothing to do with health IT.
As a patient advocate, I have personally experienced in terms of a pathway for a patient journey. For someone in my family who has been suffering with Alzheimer’s disease and vascular dementia, it’s been an 18-month period of tumultuous change in her quality of life. The challenge for us has been trying to incorporate her story into all the data within her EHR made difficult by a disconnect between her approach and actual experience.
She is someone who tries to put her best foot forward for the event of the clinic visit. From her physical appearance to her approach answering questions about her health, hers has been an attempt to be optimistic, dignified, and strong. But the reality of her experience has been quite the opposite, and that story may have something to do with her current condition.
There has been a consistent unwillingness among her providers to integrate the context of her story with this current data. For the pathway of the ongoing patient experience these questions may serve a great starting point in the culture of care:
• Where are you now?
• Where do you want to go?
• How do you get there?
As an enabler for the clinic’s work on continuity of care, the EHR might be the realization of better, faster, and cheaper. But it’s more important to first envision what this new culture of care will look like, and how everyone will be a part of it in the defined community of care.
In fact, defining what the community of care is for the clinic may be an important yet overlooked step in the context of the EHR and the clinic value proposition. The EHR partner in the clinic is important, but the relationships with other providers of care are even more important for the sustainability of the clinic and patient satisfaction.
What kind of interactions do we want in the clinic? It does matter for not only a new patient experience but also but a fully engaged staff as well. The journey to more accountability in healthcare is underway, and it’s a much different conversation than the old advice, “Take two pills and call me in the morning.”
We all know in our own ways how complicated healthcare can be, but we also recognize that applying health IT does not necessarily make anything about this scenario any easier for patients or providers. What we do know is that we can do better, all of us, in human interactions and being accountable for health outcomes.
Robert Green is the author of Community Healthcare: Finding a Common Ground with New Expectations in Healthcare. Through his physician client relationships, Bob has gained substantial insight regarding the daily challenges that medical professionals and their staffs face, such as regulatory issues, financial management, and clinical collaboration through the use of health IT. His process of making both interpersonal and purposeful connections within the organization results in improved employee performance and confidence and enhanced client experience.
