In this issue of OSN, our cover story explores the new MACRA and MIPS quality of care rules from CMS. Many physicians are frustrated by the requirement to document their quality of care through these standards. For most, it is frustration over just another unfunded mandate — a process that consumes time and energy to prove we are meeting standards that most of us have met forever. Let’s explore this problem and some solutions that are on the horizon.
Why should documenting MACRA quality measures really take extra time and effort? Eighty-five percent of ophthalmologists in the U.S. use electronic health records rather than paper charts. Shouldn’t these software systems “read” our charts and compile the required data for us effortlessly? Unfortunately, many systems do not. To extract the needed data requires costly updates and modifications. So the problem is not compliance with easy standards. It’s the pain of getting our EHR systems to do their jobs.
To me, this underscores a fundamental gap in EHR systems — that we have to work for them rather than the other way around.
Many doctors view their EHR system like an autocratic dictator they must worship, bowing in servitude to the keyboard and screen rather than making eye contact with the patient. Many of us free ourselves of the screen by hiring a scribe. This adds one full-time employee to the already expensive cost of the records system. More than one survey of physicians has shown that EHR costs much more time and money than it saves in a medical practice.
But have hope, good doctors, it won’t be this way forever. If Siri can anticipate when you are leaving for work and update you on traffic conditions, why can’t we create artificial intelligence-driven EHR? Why can’t we have systems that listen to the patient interview, recognizing the difference between staff and patient voices, and document the history, populating all the fields for E&M coding? Why can’t systems automatically detect high-risk patients based on diagnosis codes and chart notes, and automatically flag those lost to follow-up? Yep, these are challenges we all face, and their solutions would have a significant positive impact on our patients. Now that’s efficient quality of care.
The technology to solve all these problems exists today, but it will take some time to implement it. It will take physician, not just programmer, involvement, and yes, there will be a cost. But think about the benefits of any one of these advances. Each one would be game-changing for us.
We created a solution called MDbackline that automates follow-up care for patients with common conditions like dry eye, glaucoma and cataract surgery. Driven by artificial intelligence, it has been beneficial in our practice and now others’, but this is just one example of an entire industry of EHR enhancements that will ease the growing burdens of patient care. Although they are outnumbered by challenges, EHRs have already provided at least some efficiency benefits. We deserve more — they can’t arrive soon enough.
Disclosure: Hovanesian reports he is the founder of MDbackline.