News & Commentary

Get More Mileage From EHRs By Using Them Strategically


In order to get the most out of EHRs, providers need to think outside the box—the box in this case being CMS’s meaningful use requirements, according to wisdom contained in a PwC survey. The three stages of CMS’s meaningful use program dangle incentives to encourage hospitals and other health care providers to improve their electronic health records (EHRs) system for Medicare beneficiaries.

Providers complain that the program places an untenable burden on them. For instance, the American Hospital Association, representing some 5,000 hospitals, wants CMS to delay implementing Stage 3 of the program, which is set to begin in 2018.

The PwC survey found that only 25% of health care providers strongly agree that EHRs help their organizations adopt to the new health economy. In addition, only 23% strongly agree that their EHRs boosted value-based care and population health strategies.

However, those providers who strategically implement EHRs tend to have a much more positive view of them. Reducing variation in care is critical to achieving better outcomes and “strategic implementers appear to be further along on digitizing clinical documentation,” the PwC report on the survey states. In almost every strategy category, the meaningful use implementers lag the strategic implementers, according to the survey.

Comparison of different approaches to EHR use
Meaningful use implementers Strategic implementers
Agree EHR has met expectations for communicating more effectively with patients 76% 92%
Face an inability to exact meaningful data from the EHR as a barrier to maximizing its benefits 30% 18%
Report operating margins of 5% or greater for the first fiscal year 39% 47%

For instance, while 39% of implementers have had EHRs in place for less than five years, 64% of strategic implementers have had it in place. Sixty-three percent of implementers use EHRs for clinical documentation; for strategic implementers it’s 84%. Strategic implementers also are more pleased with how their systems performed.

PwC conducted a telephone interview of 300 health care provider executives in August and September of 2017. The survey, which was published in October, also included information taken from in-depth interviews with 15 executives at health care delivery systems across the country.

The survey found that while EHRs store clinical data, they do not as yet fully support population health efforts. Only 36% of providers use EHRs in their population health efforts. Just 13% strongly agree that EHRs have met their expectations for population health management.

PwC spoke to David Chin, MD, a distinguished scholar at the Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Medicine.

“The EHR by itself is insufficient for population health analytics because patients cross systems,” he told them. He thinks that the implementation of more health information exchanges (HIEs) might be one way to address this problem. HIEs allow providers to share patient histories and data regardless of where the care is provided.

PwC’s write-up of its survey mentioned a recent study published in the New England Journal of Medicine that found that social factors and environmental exposure such as pollution account for 20% of premature deaths.

“When it comes to a person’s health and well-being, all the data in a provider’s EHR only account for one third of what is needed,” Jonathan Weiner, director of the Center for Population Health IT at Johns Hopkins University, told PwC researchers.

PwC offers several recommendations for providers. They include tightening up data governance, and considering using a vendor to construct the EHR system.