The primary conceit of the Electronic Health Record (EHR) is its ability to reduce administrative costs and burdens on healthcare professionals. By establishing a single electronic record containing data on patients’ medical history, demographics, medications, immunizations, test results, etc., it was thought that healthcare providers’ workflows would be simplified. By so doing, EHRs were expected to lower administrative costs and enable providers to better create care plans for their patients.
However, there have been a few bumps in the road. At a Health and Human Services listening session held in February, primary care providers complained at length of documentation difficulties, clunky and tedious reporting processes, and having to get EHR approval to provide tests and medications. Issues such as the requirement for doctors to re-record medical students’ notes into the EHR and important data being buried under less salient information were just a sampling of some of the specific grievances noted.
Additionally, the cost has not been shown to have decreased. A Duke University study drawing data from 2016-17 found that the cost of generating bills, the area specifically targeted for savings by EHR, remains quite high—up to $215 for the right kind of visit.
So what’s happening?
We’ve already addressed some of the issues above, but the Duke University study yielded some telling findings: a physician’s time is worth approximately $3–$8 per minute, and the EHR requirements and workflows require them to spend 13 minutes for billing and insurance activities for a typical primary care visit; for something like an inpatient surgery, the amount of time shot up to 100 minutes. Because the EHR requirements for payment and billing, and the need to administer payments to a complex system of different payers and health plans, it appears the savings made by the EHR in one area are being offset by new added administrative burdens placed on physicians.
Perhaps the issue is that EHR by itself is not enough. One of the difficulties of EHRs is that they do not capture sufficient data on the social determinants of health (SDOH). EHRs may not be able to reduce the number of payers or plans at play with providers, but if they are wielded in tandem with other crucial elements as a part of a Whole Person Care approach, they may be able to help reduced burdens, administrative and financial, in a different way.
The impact of the social determinants of health on healthcare costs and resource allocation is well known. Approximately 5% of the U.S. population accounts for 50% of healthcare spending, and much of this 5% suffers from issues that cannot be treated by a physician but are part of the social background of the individual, including mental and behavioral health issues, housing and food insecurity, or financial stress, which can all contribute to a higher prevalence of chronic diseases and health emergencies.
The Whole Person Care paradigm operates under the assumption that if we can address these issues—treating the whole person and not just symptoms—we can remove the stressors contributing to the extremely poor health of this most needy portion of our population and achieve better health outcomes for them, which, in turn, would drastically reduce healthcare expenses and free up a great deal of resources. For instance, a clinic such as Dr. Wyatt West’s Mountain Valley Weight Loss at Tanner Clinic focuses on helping his patients lead healthier lives by focusing on rapidly increasing social determinant of health: obesity, a condition that leads to many chronic, life-threatening, and very costly conditions.
One of the benefits of an EHR is the ease with which physicians can share data about patients, but part of the challenge of addressing the social determinants of health is a significant communication and infrastructure gap between healthcare and the social/behavioral programs and services present in communities across the country.
Comprehensive Care Plans designed to bridge this gap are gaining traction around the country. Such a plan involves linking the social services and healthcare providers in a given community, with special focus on targeting the geographic areas and demographics that make the most strategic sense—areas with high rates of poverty, for instance, which are often correlated with areas that have high densities of Medicaid recipients, high rates of chronic disease, and high rates of emergency services usage.
The information captured in EHRs does not, however, include social determinants of health data—at least not at the level needed to formulate a strategy. Epic executive Josh Holzbauer wrote that the future of the EHR is the Comprehensive Health Record (CHR), and he highlighted many new and interesting features and technology that are to be integrated into the CHR—but notably, the CHR as described does not capture housing data, one of the most crucial SDOH data points, without which, truly addressing SDOH is not possible.
What communities and providers need is an integrated software solution that connects to an organization’s EHR and incorporates medical, behavioral, and SDOH data into a Comprehensive Care Plan. From the Comprehensive Care Plan, physicians are able to see which patients need which social or behavioral services and, within the care coordination platform, they can match and refer patients to those services. By treating the whole person rather than simply symptoms, a Comprehensive Care Plan empowers communities to improve overall health outcomes for its neediest populations, resulting in healthier individuals, lower healthcare expenditures, and—yes—less tedious work for physicians.