I guess I would need to know if your audit results indicated over utilization of tests. In my opinion, EHR is not going to solve clinical judgment of the physician. The other component that is necessary is whether the tests meet the medical necessity criteria which are a program that can be implemented in addition to the EHR. The medical necessity criteria are for Medicare beneficiaries only, but the same concept can be applied to the commercial payors. Physicians are not coders. They will continue to order services based on what they believe will improve the patient's health. We have contracted with a consulting firm to assist with determining medical necessity for the patients and that the documentation supports the level of care.

An automated, integrated system can provide reports on specific patients as well as populations which is useful to meet Medicare program requests. A family Practice clinic implemented a chronic disease management system for patients with diabetes for three years. The physicians and clinical team studied results after one year and made changes in their process to include clinician reminders for the patient’s next visit, referrals for eye examinations, and sending letters to patients requesting follow up lab visits or appointments with their physician. This created the foundation for a future planned visit with the patient. Consistent monitoring and measuring of these indicators and reviewing results as a team to plan patient care have improved the quality of care for these patients.

This is a success of how EMR made a difference in quality initiatives. This is awesome.

I agree with your comments, Nicole. Physicians will continue to base their their treatment on their beliefs unless they are educated fully on all of the aspects of medical necessity. At my organization, the Kaiser physicians have been more consistent and compliant with their medical treatment. We have both Kaiser and non-Kaiser physicians so it is very frustrating to see the differences.