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Four Essential EHR Features for Your Population Health Management Program

It’s been a little more than 13 years since the Health Information Technology for Economic and Clinical Health Act (HITECH) promoted the adoption and meaningful use of health information technology, specifically electronic health record (EHR) systems. Now, more than 86 percent of physician offices have adopted them, giving them the ability to capture individualized data that can be communicated among multiple providers and inform ongoing care. 

EHRs offer other advantages, including helping providers identify patients who have a gap in care, generating numerous reports to help them actively manage patients and promoting timely, patient-centered care, all of which help improve the quality of care they deliver. According to the Office of the National Coordinator for Health Information Technology (ONC), 75 percent of healthcare providers say their EHR enables them to deliver better patient care, which results in higher patient satisfaction rates and fewer medication errors. 

One newer area in which EHRs are increasingly being utilized is population health management (PHM). Used correctly, they have the potential to improve public and population health outcomes — if they have the necessary features and capabilities that enable them to analyze data across groups of patients. 

ERH technology employed by physician practices and other medical groups for PHM should allow for patient-entered data, the ability to screen patients in advance of an appointment and customizable forms. Such systems also must enable interoperability, a challenge still faced by many healthcare providers. Following is a list of four features an EHR should have to support population health.


1. Patient-Entered Data

Accurate and complete data is essential for quality patient care. Information entered into EHRs manually by patients and provider staff, though, heightens the risk for medical errors due to an incomplete medical record or one that’s not up-to-date. 

When patients can input their personal health data through a secure connection, it helps to lessen the information gap between them and their providers. For providers, having clinical data accessible through the EHR aids them in avoiding poor quality decisions and possible subsequent adverse events. Other advantages of using patient-entered data are:

  • Physicians receive more data than they would from a conventional history.
  • Patients are more likely to reveal social secrets to a computer than to a physician.
  • The information is provided in a format that can easily be read before the patient visit.
  • If the patient is able to complete a pre-visit interview before the office visit, then the office visit is streamlined even more. 
  • Pre-registration helps organizations create a higher quality consumer experience and increase patient satisfaction by collecting patient intake materials ahead of the appointment.

The ability to collect, summarize and integrate patient-entered data into an EHR facilitates improved clinical care by providing a more nuanced and accurate assessment of health status outside of the typical brief clinical visit. By allowing providers to collaborate with patients as partners in clinical decisions, patient engagement is easier to achieve, resulting in more open communication between the two parties. 

2. Pre-Visit Screenings 

By planning for a patient’s visit before he or she even steps into the office, healthcare providers can better close gaps in care. They’re able to achieve this by using technology that not only provides quick and easy access to real-time data but also allows patients to enter information that is then integrated into the EHR. The result is more time spent on patient care and less on administrative tasks. 

Through screenings included as part of an EHR, patients can fill out on their mobile device pre-visit questionnaires about depression, fall risk, pain, substance use and more, especially for Medicare Annual Wellness Visits (AWVs). This data is then part of the patient’s comprehensive record, so he or she doesn’t have to fill out paper forms multiple times — with the same information. 

EHR-based screening tools also help physician practices screen for social determinants of health (SDOH), a feature that enhances their PHM program. A research article published in the Journal of the American Board of Family Medicine reported that such tools succeeded at increasing screening rates for behavioral health

3. Custom Forms 

Physician practice staff have to deal with a variety of patient forms, including those for consent, HIPAA, insurance verification, referrals and new patient registration. Giving patients the ability to digitally complete these and other necessary forms before their scheduled appointment reduces data entry, saves time and decreases the risk of transcription errors. Once they’re imported into the EHR, providers can easily and securely share them with other clinicians and healthcare facilities when requested. 

When these EHR forms are customizable, medical groups can edit them based on their specific needs while still offering them to patients in an easy-to-read and understandable format. Most importantly, using custom forms to automate the data-gathering process enables physicians to spend more time on patient care. 

4. Interoperability 

Approximately 78 percent of physician practices now utilize EHRs, but there still is a lack of accessible and interoperable patient data. Different healthcare IT systems may use unique clinical terminology, making them incompatible with other solutions. This absence of interoperability may lead to physician burnout, which has been directly linked to an array of problems. 

When interoperability is achieved in healthcare, it provides clinicians with easier and real-time access to complete electronic health records, allowing them to have the most up-to-date patient information and make more informed decisions about a patient’s care. As the ONC notes, it also enables better workflows and reduced ambiguity. 

Epion EveryWare allows health systems to use automated campaigns and artificial intelligence to manage the unique needs of large patient populations at all points of the care continuum. The result is a continuous and patient-first approach to care, which delivers improved outcomes while reducing costs and burdens on staff. Contact one of our talented team members today to learn more!