Alrighty. Good afternoon everybody. First, I want to say we appreciate you very much. Thank you for spending an hour of your day with us. We host customer webinars that focus on training for our products and services, but we also want to be a good corporate citizen and support the industries we serve.
My personal goal for this session is to give you something meaningful:
- A bit of food for thought
- Something new you may not have known
- And at the very least, something that sparks internal conversations later
I believe the EHR is the foundation for the house. Again, thank you for spending an hour with us.
A Look Back: Where We Started in Healthcare IT
I am going to date myself here. I started in healthcare IT in 1994. Everything was green screen. To get a report, we had to run green and white paper. Our connectivity was a modem. For the younger folks, that may sound ancient. That server in the back room that ran the Unix operating system and handled billing cost over five thousand dollars, just for that box.
We have come a long way.
Before meaningful use and the HITECH Act, most systems were simply management and billing systems. There were no real standards, other than for billing. We were printing off HCFA forms. HIPAA brought electronic claims, but storage was scattered and unstructured. We recorded only enough information to get paid. Sharing data across providers was not something we thought about.
Nationally, we were not focused on lowering costs except through electronic claims on the billing side.
The Shift: Federal Standards and Certified EHRs
The federal government, through the stimulus program, created incentives for healthcare providers and IT companies to adopt certified EHRs. Standards were set for the United States. There are multiple types of certifications, such as modular e-prescribing only or complete certified EHRs like Patagonia Health.
The HITECH Act also created national standards for privacy and security, which are higher than those for banking.
But the main push was for structured data and interoperability. I believe the EHR is simply the foundation of a complete healthcare IT ecosystem.
Industry Changes and Integrated Care
From 1994 to 2009 to 2018, the progress has been huge. About 88 percent of hospitals now have certified EHRs. In social services we are at around 50 to 60 percent, but growing quickly.
Across the country, integrated care models are rising. Examples:
- Rural Appalachian areas with no Medicaid providers, where the public health department created its own FQHC
- Behavioral health agencies in Utah offering primary care for residential programs
- Public health departments in Michigan doing teen clinics and adolescent health
- Rural Maryland health departments acting as behavioral health agencies due to lack of community mental health centers
If you do not have a solid foundation, think about where your agency is going. Patagonia has grown rapidly. When I joined a little over four years ago, we were in one state and now we are in twenty-one.
Make sure your EHR foundation supports the future.
Why Build on the EHR Foundation?
Goals of a strong EHR foundation include:
- Improving patient care
- Improving patient satisfaction
- Reducing errors
- Improving staff productivity
- Reducing costs
- Ensuring payers and funders reimburse you
Grants are being cut. You are asked to do more with less. Productivity matters.
Changes in Funding, Reporting, and Private Insurance
Years ago, behavioral health and public health relied heavily on grants. Reporting was basic. Private insurance billing was rare.
Today:
- Public health has Title V and Title VII reporting
- FQHCs have UDS reporting
- Hundreds of smaller grants require their own reporting
- Private insurance has higher deductibles and requires real-time eligibility
- Medicare and federal programs introduce more requirements
- Pay-for-performance and outcome measures are increasing
Accurate reporting matters more than ever.
Accreditation Pressures
Accreditations have grown significantly in recent years:
- Public Health Accreditation Board (PHAB)
- JCO for departments offering primary care
- CARF for behavioral health
Accreditation requires quantitative and qualitative data. Structured data is essential.
Improved Reporting Tools and Dashboards
Dashboards allow leadership to quickly monitor data such as charges, revenues, and rejected claims. Meaningful use measures can be tracked at a glance.
EHR data can also be exported into tools like SPSS for advanced analytics.
Mapping Data for Better Decisions
Many counties use ESRI or ArcGIS. Examples from customers:
- Mapping syphilis cases to identify outbreak clusters
- Comparing flu clinics to flu diagnoses
- Mapping obesity rates against sidewalk coverage to influence county board decisions
Visualizing EHR data improves decision making.
Hardware that Improves Accuracy and Productivity
Examples include:
- 2D barcode scanners for vaccines to avoid transcription errors
- Signature pads for consent forms
- Scanners for insurance cards
- Device connectivity (for example, Welch Allyn blood pressure devices connecting via Bluetooth)
Interoperability: Connections That Matter
The EMR is the hub in a larger healthcare ecosystem. Key interfaces:
- Immunization registries (unidirectional or bidirectional)
- Surescripts e-prescribing network
- Lab interfaces (LabCorp, Quest, and others)
- State and regional Health Information Exchanges (HIEs)
- Direct secure messaging solutions for areas without an HIE
FirstNet and First Responders
Congress set aside frequencies for high-speed mobile broadband for first responders, called FirstNet. Ambulances use EPCR systems. Think about future integration: sending patient summaries to EMS during emergencies, for example.
Beyond the EHR: Thinking Creatively About Connectivity
Ideas and examples:
- Referrals between environmental health systems and the EHR
- Interfaces to county accounting systems
- Case management and third-party reporting tools
- Analytics platforms for deeper insights
Patient Engagement
Tools include:
- Automated appointment reminders
- Outreach campaigns (for example, flu shot reminders to thousands of patients)
- Patient portals with secure messaging
- Patient access to immunization records, health summaries, and downloadable CCD files
Engaged patients experience better outcomes.
Population Health and the Future
Population health brings together all stakeholders: government, providers, hospitals, patients, public and private practices.
Future trends include:
- Wearables and patient-generated health data
- Telemedicine
- Use of HIE data for broader analytics
- Care coordination and referral tracking
- Medication adherence tools
- Device-connected chronic care management
Q & A Session
Monique: I was chuckling about your copay story. Sounds like your doctor needs a better foundation.
Tom: Yes, real-time insurance eligibility is essential. I recently had pneumonia and spent 25 minutes waiting while they figured out my copay.
Monique: Can you clarify the requirements for bidirectional interfaces with labs and immunization registries?
Tom:
-
Immunization registries:
- Unidirectional: EHR uploads what you did today.
- Bidirectional: EHR downloads history first, then uploads today’s shots. Often includes inventory support and the ACIP recommender.
- Unidirectional: EHR uploads what you did today.
-
Labs:
- Unidirectional: Lab sends results.
- Bidirectional: EHR sends orders and receives matched results.
- Unidirectional: Lab sends results.
- State labs often lag in HL7 support. Keep pushing them.
Monique: If an agency migrates from a legacy system, can they bring lab data into the new system?
Tom:
It depends on the legacy system. If data can be extracted and mapped, yes. If not, printing to PDF and uploading into the patient’s digital file cabinet is an option.
Monique: And not all EHRs handle data formats the same way.
Tom: Correct. Old systems may store gender as simple codes, for example. Newer systems track gender at birth and gender identity. Mapping is important.
Monique: Last question: EMR Direct is a direct messaging feature. Do all EHRs have that?
Tom:
Not all, but many certified EHRs support some form of direct secure messaging. It allows local data exchange without an HIE and is affordable.
Closing Remarks
Monique: The explosion of wearable products and telehealth tools means a solid foundation is essential for future growth.
Tom: Thank you for spending an hour with us today. I hope you learned something or at least found some food for thought. Patagonia Health appreciates your time.
Monique: Thanks everybody for joining us. We hope to see you on future webinars.
