Texas Tech University Health Sciences Center



With the advent of Electronic Health Records (EHR) in the late 2000s came rampant resistance. Meaningful Use requirements forced healthcare organizations to begin implementing an EHR but many were unhappy about it. As we transition from fee-for-service to value-based care – from volume to value – and move from current state to MACRA, adoption of EHRs has become both necessary and nearly universal.

As of 2015, nine out of 10 office-based physicians had adopted an EHR.  As of March 2016, more than 90 percent of hospitals eligible for the Medicare and Medicaid EHR Incentive Program have achieved meaningful use of certified health IT.[1] Overall, 96 percent of hospitals have adopted CEHRT.[2]

However, near universal adoption doesn’t necessarily translate to 100 percent acceptance. When it comes to incorporating an EHR, many providers have undergone the five stages of grief - denial, anger, bargaining, depression and finally now, to grudging acceptance. Like death and taxes, EHRs are here to stay and will remain an integral component of the healthcare landscape of the future.

The reality is that EHRs are essential if we hope to meet the overriding goal of providing better healthcare outcomes at reduced costs. EHRs form the basic building block for much of what needs to be accomplished in healthcare. Here are three key initiatives that rely on EHRs for their ultimate success.

Evidenced-Based Medicine (EBM)

Evidence-based medicine has gained popularity in recent years because many see it as the ideal way to address the concepts of Triple Aim – enhancing the care experience, improving healthcare outcomes, and reducing per capita costs of healthcare. EBM involves three important components of healthcare – research-based evidence, clinical expertise and the patient’s values and preferences.

Universal adoption of EHRs now offers providers access to a much larger data set of real-time data. This access can significantly add to the clinician’s knowledge base and drive better data-based decisions.

EHRs allow us to analyze data to the degree that we’ve not been able to up to now because we can look at a census versus a sample. In a census, you’re looking at 100 percent of the data.  In a sample, you’re only looking at a subset of data.

For example, there are more than 30 different statins (including generics) that can be used to treat high cholesterol. We can mine EHR data to determine which one is the most effective with people in a targeted demographic with certain characteristics. We now have the capability, for example, of studying different treatments for pneumonia and congestive heart failure. Previously our ability was limited to a sample size of maybe a hundred people or so. Thanks to EHR data we can sample 200,000 people, or more, to help develop standard protocols and better care outcomes.

We’re no longer limited to one research assistant with a clipboard flipping through medical records making tick marks. We can set up a program that would abstract specific information from a vast database to help us make more effective decisions. The more data we have, the more confident we can be in our conclusions and EHRs provide an enormous amount of data from which to do our research.

Population Health

As we move toward more value-based care reimbursement models, organizations are signing contracts to care for large groups of people for fixed fees. In some cases, there are shared savings arrangements. Understanding the populations for which they are responsible and developing detailed care strategies for them can be the crucial difference between financial health and financial loss. We know prevention and early detection are key. The goal is to find a disease before it becomes chronic and expensive to treat.

EHR data allows organizations to sort patient populations into various categories based on BMI, blood pressure, diabetes, chronic illness, age, level of exercise, nutrition and many other factors. This information can be used to plan effective interventions and study the subgroups for proactive ways to drive improved outcomes. Groups of patients can be triaged to identify those who are at greatest risk for serious illness so clinicians can develop ways to prevent or mitigate those risks. Just think of all this data, starting with the EHR, plus data from digital scales, Fitbits steps, and genetic test results -- all being crunched, in real time, as computers look for patterns.

CMS is driving the healthcare industry to a point where organizations will get paid based on how well they manage the health of a group of people. EHR data is a significant tool in helping organizations succeed in this evolving environment.

Patient Engagement

The desire for patients to participate in their healthcare decisions is a key component of the growing consumerism of healthcare. CMS is pushing patient engagement even further with their recently released Person and Family Engagement Strategy (PFS). The goal of PFS is to encourage patient engagement and promote tools and strategies that create a cooperative environment between patients and care providers.

One of the key vehicles for engagement is the patient portal. Patients and physicians can enter data into a single source of record for each patient. In this way, EHR becomes not just a digital conversion of the electronic medical record, but a repository that includes the history of patients’ interaction with clinicians as well as vital data they can enter. Patients can add medications, exercise and blood pressure directly into the portal.  As previously mentioned, eventually we’ll be taking information from wearables plus other devices and uploading it into the EHR.

We’ve all seen recent announcements that retail stores like Macy’s and Sears are struggling as people shift to buying online rather than in physical stores. We are seeing the same thing in healthcare. Instead of calling a physician, being put on hold, asking for lab results or other information, people want to go online in a secure environment and access their health information. They not only want to view results but they want them put into a context where they can understand them and act on them. They want to set appointments convenient for them and to pay their bills online. And, eventually, they want to interact with the physician online through a virtual visit.

The EHR will eventually take the individual’s micro data and combine it with the general population’s macro data to provide the patient with detailed information. Using online tools can make the interaction more personal without the rush of activity that usually exists in a physician’s office or hospital setting.

EHRs open a portal to greater engagement by the patient and facilitates better messaging between the patient and the clinician.  It can help mend the fractured healthcare delivery system by providing one electronic repository with all the patient’s information.  Today we are seeing a growing number of systems and physician practices opening up access to unedited doctor’s notes, and the results are positive. Patients report information to be helpful and enlightening.

The time has come for providers and organizations to not only accept EHRs but to embrace them and recognize that they are the cornerstone for everything we hope to achieve in an ever-changing healthcare environment. The success of these three initiatives and many others to come are not possible without the effective use of EHRs. This basic building block is crucial in constructing a foundation for the healthcare industry of the future.

By Brent D. Magers, FACHE, FHFMA, CMPE, Executive Associate Dean and CEO, Texas Tech Physicians

[1] Quick Stats, Health IT Dashboard, The Office of the National Coordinator for Health Information Technology, December 20, 2016.

[2] Certified EHR Technology Adoption Reaches 96% Nationwide, by Sara Heath, ehrintelligence.com, September 29, 2016