The Electronic Health Record: An Essential Tool for Driving Optimal Clinical Outcomes

In previous blogs I have talked about the highly fragmented care our patients receive, and how this leads to poor outcomes. This comes as no surprise to any busy nephrologist who struggles to juggle the multiple renal and comorbidity-related issues for these complex and fragile patients.  Most advanced CKD/ESRD patients are seeing 3- 4 additional physicians including a primary care doctor and multiple specialists. The ability of the nephrologist to know what is happening, in real time, is nearly impossible in the current care paradigm.

Within the dialysis facility there is a reasonable level of sophistication in the electronic capture, analysis and reporting of relevant clinical data to the nephrologist. Dialysis providers have developed systems that capture clinical and billing data and such information is increasingly becoming available to nephrologists not only in the dialysis facility but through security-protected web portals.

This is all fine, and some systems are more robust than others, but the real problem remains that only a fraction of the healthcare received by these patients takes place in a dialysis center. There is a crying need to have a truly integrated electronic health record (EHR) so that the care delivered by all relevant physicians, at all sites of care, including hospitals, will be available to the nephrologist in real time.

Now, adding the fact that Nephrologists providing dialysis care may have up to 85% of their patients on Medicare, the failure to implement “meaningful use” of a certified EHR in their practices sets them up to lose revenue due to reimbursement penalties imposed by the government.

Because of the complexity of nephrology practices and the diversity of their daily workflow, a nephrologist would be hard pressed to take a cookie cutter EHR “off the shelf” and expect that it will not only help them avoid reimbursement penalties but actually optimize the care of their patients.

There is good news here – some dialysis providers have decided to throw their hats into the ring and develop nephrology-focused EHRs. The key to nephrology-focused EHRs is that they have been created with the specific needs of nephrologists in mind. At least one of the nephrology-focused EHRs on the market integrates data from dialysis facilities into the nephrologist’s office EHR system to manage patients with ESRD. Such systems are also capable of capturing data in the office on CKD patients in a way that covers the continuum of an individual patient’s renal disease progression. If ACOs become a reality, the EHR that has the flexibility to truly integrate all relevant data as it becomes available, will be better positioned to close the loop – optimizing the delivery of patient care, as required by CMS for any approved ACO.

Bringing an EHR into the nephrology office is to some a daunting task, requiring large capital expenditures and technical expertise. Dialysis providers developing such systems and commercial vendors of generic EHRs being marketed to nephrology groups need to have the flexibility to work collaboratively with nephrology practices to address these issues to help ensure that the practice realizes the full potential of their chosen EHR  to improve care for patients and ease the administrative burden. If this can be done, nephrology patients will receive better care, and integration of care will be much more likely to accelerate.

As clearly stated by President Bush and President Obama:

“We need to reduce costs and medical errors with better information technology.”
President George W. Bush;  State of the Union Address;  January 23, 2007

“Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives.”
President Barack Obama; Address to Joint Session of Congress; February 24th, 2009

I look forward to your comments, until next time.

Striving to bring quality to life,

Allen R. Nissenson, MD

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