It seems counterintuitive, but in healthcare, it’s often the things you can’t see that are most important. Providers and payers need to see the patient and the patient’s medical records, of course, but finding where care is missing is perhaps the most critical and challenging issue these days.
Care improvement experts from the government and elsewhere have endorsed the idea of care gaps being addressed using a medical record review (MRR) process in which medical data is retrieved from providers’ electronic health records (EHRs). The data retrieved from EHRs can then be used to
Unfortunately, the traditional MRR process is difficult, requiring hours of manual labor. Then there is also the need to identify care gaps and provide patient-level decision support at the point of care—a need which is growing as a result of drivers like the Affordable Care Act.
The answer lies in streamlining the process so that targeted medical record data is automatically retrieved to be examined for quality and risk score accuracy. This requires systems that enable interoperability across EHRs as well as integration services that exchange data leveraging health exchange standards and enable provider participation through a flexible enrollment process.
Specifically, a medical record retrieval system should be able to accomplish the following:
Once these workflows are set up and functioning properly, the next step is to use the platform to deliver health plan care-gap information directly into the point-of-care workflow, further enhancing quality improvement and risk score accuracy programs.