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Taking the Medical Record Review Process to the Next Frontier

August 20, 2014

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

  • Create a comprehensive profile of the patient’s medical history
  • Generate lists of patients with a high-value suspected diagnosis
  • Trigger timely alerts to providers about suspected healthcare gaps upon patient check-in (via EHR messaging)
  • Dynamically integrate patient care-gap data with EHR data to confirm the patient’s most-current health status and drive accuracy in the delivery of patient care
  • Embed patient-specific gaps into physician medical progress documentation

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:

  1. Use analytics to produce a monthly (or weekly or daily) medical record “chase list” of records required to support NCQA, CMS, or state agency quality and risk score accuracy requirements.
  2. Send a copy of the medical record chase list securely to the EHR vendor for MRR.
  3. Ensure that the EHR vendor securely sends an electronic continuity of care document to the provider or, if not, that the MRR retrieval is completed though traditional methods.

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.

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