New EHR helps Eastern Nephrology improve care and boost provider satisfaction
Eastern Nephrology Associates is a nephrology practice in eastern North Carolina and northeastern South Carolina consisting of renal specialists providing nephrology, renal dialysis, renal transplant and hypertension care in 14 offices, more than 40 dialysis centers and two vascular access centers.
THE PROBLEM
Eastern Nephrology’s EHR worked well in the typical fee-for-service reimbursement model. However, nephrology practice began to transition to value-oriented care in 2018.
One of the first challenges the practice faced was the ability to identify patients assigned to value-based care programs at the point of care. There was no register or label in the graph indicating whether they were part of a value-based program. There were separate lists that staff referred to to identify these patients, and it was significantly burdensome for the healthcare providers and management team.
“The second big problem for us was that the data was siled and difficult to retrieve,” says Dr. Carney Taylor, director of Eastern Nephrology. “Our office’s EHR did not communicate in a seamless manner with the hospitals or dialysis units. It’s difficult to care for patients effectively if you can’t see the entire continuum of their care.
“For example, if a hospital admission occurred, we had no visibility into it unless we printed the file and scanned it into the media tab of our EHR,” he continued. “This required a lot of manual effort.”
The next problem staff encountered was that even in their own EHR, the data was isolated to provider notes, making it difficult for care coordination team members to find the information they needed. It made care coordination very difficult.
“As patients transition from chronic kidney disease to end-stage renal disease, there are numerous things that need to happen for the transition to be successful,” Taylor explains. “Care coordination involving multiple team members is critical to achieving optimal patient outcomes during this transition, but our EHR did not have a common and easily accessible location for mapping care coordination.
“Providers entered some care coordination data into their notes, forcing our care coordinators to open up each individual encounter to identify the care plan,” he added. “In short, it was not a very efficient way to understand the progression of chronic kidney disease in a patient.”
And finally, while staff could create standard reports in the EHR, the reports were not intended to help achieve performance goals on certain quality measures tracked in new value-based care agreements with government and private payers.
PROPOSAL
Acumen was originally developed as a nephrology-specific EHR, so it was structured to facilitate nephrologists’ workflow.
“Right before we looked at it, it was turned into the Epic platform, so we were enticed that we could leverage the benefits of Epic while maintaining a nephrology-centric focus,” Taylor said.” We saw that Epic could help solve our issues around siled records, as many of the hospitals and other vendor offices in our region were using their own copies of Epic.
“The interoperability of the EHR across healthcare environments has been exciting,” he continued. “Additionally, we liked the idea that Acumen would continue to focus on nephrology practices. The ability to have our EHR adapt to the way we need to care for patients was critical.”
Taylor was also optimistic that Acumen would continue to invest in functionality that would solve some of its value-based care challenges, such as identifying patients who are in value-based programs at the point of care and developing better documentation tools for care coordination.
MEETING THE CHALLENGE
Eastern Nephrology was integrated with Acumen Epic Connect (electronic medical record software for renal physicians) in May 2020. Due to the pandemic, it was the first practice to switch to the platform in a virtual environment.
“Transitioning to a new EHR can be a traumatic experience for providers and physician practices, and doing so during a pandemic posed additional challenges; but today our entire team uses Acumen every day,” said Taylor. “It’s essential for every operational activity, from patient care to reception and revenue cycle management. It’s a complete solution for us.
“We partnered with a value-based care management company, Interwell Health, in 2019,” he continued. “Interwell Health subsequently acquired Acumen in August 2022 and has continued to invest in improving how the EHR facilitates our value-based care services.”
For example, built-in tools within Acumen help staff conduct and document encounters with chronic care and transitional care management. The staff is also beginning to integrate remote patient monitoring. Integration into the EHR through Acumen’s partnerships with RPM vendors will be critical, Taylor noted.
“The new EHR has now become a critical driver of our success in value-based care,” he stated. “In fact, we were able to shift from the mindset of thinking of our EHR as a place where we can complete documentation and care for one patient, to using it to not only capture data, but also to to be used for analysis to provide useful information and plans.” care for all patients.
“The Acumen team continues to help train our suppliers and staff to get the most out of the system,” he continued. “The transition allowed us to make care coordination more efficient. Acumen’s intuitive design accelerated the process for the care coordination team, including our front desk staff, and saved significant time for nephrologists.”
The integration with Acumen has given staff a complete view of where and when care was delivered for individual patient journeys, he added.
“Acumen also enables the discrete collection of data we need to create more detailed reports to also understand broader trends and issues within our patient populations,” he said. “The ability to pull these reports instead of manually creating them also saves time and provides valuable insights about our patients as a whole.”
RESULTS
“Providers don’t have free time in their day. If an EHR makes their day easier, it’s invaluable,” Taylor said. “Their support is much easier to obtain when the EHR makes seeing a patient easier.
“There are a number of results that underline what we have achieved,” he continued. “One clear achievement is the optimal start, which describes when a patient begins dialysis on a home modality, receives a preventative transplant, or begins in-center hemodialysis with permanent access. Ultimately, an optimal start is more efficient, reduces hospital admissions and improves outcomes. and reduces costs.”
This year the optimal starting percentage was 90%. Previously, the optimal start was 40%.
“We have been able to significantly improve the care we provide to our patients and our EHR certainly plays a role in that,” he said. “If you look at the transplant lists, that’s the other area of success. Not everyone needs to be on dialysis, so our ability to refer patients and secure transplants has increased.
“I’m reminded of the time one of the physicians in our group recently told me that our investment in value-based care had made it easier and more satisfying for him to do his job,” said Taylor.
“He recalled meeting a patient he had not seen in four months and being pleasantly surprised that the patient had completed his treatment. education about kidney disease, decided on a dialysis modality, had the appropriate tests done and had already met with the surgeon to have a dialysis access placed.”
The care team had completed several complex steps through coordination and collaboration. The new EHR was essential in the process and the patient received a better outcome, he said.
ADVICE FOR OTHERS
“Strategic collaboration between the physician practice and the EHR vendor is critical,” advises Taylor. “In our case, value-based care is evolving rapidly, so what we need is a strategic partner that will evolve and learn with the programs you have in place.
“An EHR vendor should focus on the things it takes for your practice to be successful,” he continued. “A true partnership means they are constantly talking to you to understand what you as a clinician are seeing in the field and providing solutions to address any issues from a technology perspective.”
For example, quality metrics for value-based care models change often and the EHR must be flexible and adaptable so that one can adapt workflows to new demands, he added.
“If you have a static EHR that isn’t really focused on evolving with your needs, it can be challenging for you to evolve,” he said.
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