Radiology should work with certified health records—not against them

Radiologists should understand the importance of using certified electronic health record (EHR) technology—now more than ever with the opening of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)’s first reporting period.

Though implementation of the technology has been hampered by incentives irrelevant to radiology, the imaging community needs to work together to create value-added activities that satisfy reporting requirements, according to an article published in the Journal of the American College of Radiology.

Large-scale adoption of EHRs was encouraged by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, part of President Barack Obama’s economic recovery plan in the wake of the 2007-2008 financial crisis. While the HITECH Act rewarded physicians for “meaningful use activities,” many of these had little relevance to radiology, according to lead author and Andrew B. Rosenkrantz, MD, an associate professor at the New York University School of Medicine.

“At the time, the mandated activities had little relevance for the practice of radiology, and spending the requisite time searching for seemingly irrelevant information in a potentially inefficient aggregator (CEHRT) translated into decreased clinical productivity,” wrote Rosenkrantz et al. “As such, radiology changed its strategy, advocating for and receiving an automatic exemption from the program’s requirements. This strategy was necessary to mitigate statutorily mandated penalties for not adopting CEHRT.”

“In retrospect, it may have been a missed opportunity to prepare for the then unforeseen future that has become the present-day reality,” the authors added.

However, certified electronic health record technology (CEHRT) is certified for “meaningful use,” and offers a platform for expanding radiologists’ opportunities in MACRA.

Relevant features include an encrypted messaging platform allowing physicians to communicate directly with patients and patient-facing educational resources, according to Rosenkrantz and colleagues.

“These internal messaging conversations can be digitally captured as part of the patient’s medical record, storing vital communications that are likely to play an increasing role in the radiologist-patient relationship,” the authors wrote.

These applications are aligned with a push towards patient engagement and shared decision making by CMS, in the form of two new care delivery models called the Shared Decision Making Model and the Direct Decision Support Model.

Another useful feature of CEHRT is the technology’s ability to capture quality data. One quality goal in radiology is reducing unnecessary imaging, often through image appropriateness guidelines or clinical decision support systems. Data gathered by CEHRT could shed light on the efficacy of those systems, according to Rosenkrantz et al.

“Radiology’s role as advocates for appropriate imaging will be strengthened by further studying complex care paradigms, diving deeper into both efficient and inefficient uses of imaging; this undertaking would be strengthened with the extensive data sets being captured in CEHRTm,” they wrote. “The future broader interconnectivity of CEHRT will also allow sharing data with national medical data registries, enhancing the ability to study best practice and root out waste.”

The unsuitability of many CEHRT incentives for radiology necessitates radiologists to make an effort to carve out niches beyond the reading room.Taking initiative and serving as imaging utilization managers, coordinating care, or using the aforementioned patient communication tools are just a few ways to provide additional value. However, these shouldn’t overshadow the core services provided by radiology, according to the authors.

“Our profession’s collective focus should now be on defining radiologist-specific activities in CEHRT, which, if correctly implemented, will allow radiologists to further leverage technology to increase our role in the health care equation,” wrote Rosenkrantz et al.