The Future of Outpatient EMR: Navigating the Challenges and Embracing Innovation

Nearly 80% of physicians are employed by hospitals, health systems, and corporate entities. This shift in healthcare dynamics is changing the landscape of healthcare, affecting practices, providers, patients, care delivery, and systems alike. No stranger to the impact on systems are outpatient Electronic Medical Records (EMRs). As the number of independent practices decrease, the role of specialized EMRs has the potential to become increasingly diminished. 

In light of this evolution in healthcare, outpatient EMR systems must innovate to navigate the current challenges and harness opportunities to meet the needs of a changing market. 

Medical practices are feeling increased financial strain as the price of labor for practice administration support increases. A quarter of the $4 trillion spent on healthcare in the United States goes to administration costs. Healthcare spending is predicted to reach 7.2 trillion by 2031, which only means higher administrative costs. 

The extra business and margin pressure is particularly impactful for independent practices, which already struggle to maintain profitability. As a result, we’re seeing a decline in independent practices as physician owners increasingly sell their practice to health systems rather than to more junior physicians. 

It’s not good news for outpatient-focused EMRs. As practices are acquired by larger health systems, they usually adopt the existing system’s EMR, such as EPIC or Cerner. These EMRs aren’t always optimized for outpatient care either. So, why specialized outpatient EMR systems are better suited to the needs of this population, their role is diminished with each acquisition of independent practices.

Yet there’s an opportunity for Outpatient-focused EMRs to address independent practices’ cost concerns through automation, improved revenue cycle efficiency, and better integration architecture. 

If outpatient EMRs are going to not only survive but thrive in this healthcare landscape, they’re going to innovate. The good news is that there’s plenty of innovation to be had with these systems. Below, we’ve captured our top three recommendations for outpatient EMR innovation in the coming years. The driving factors for these transformations are increased efficiency, enhanced care delivery, and reduced burnout. 

Physicians spend an average of 15.5 hours per week on paperwork, with roughly nine hours allocated to electronic health record (EHR) documentation. Outpatient EMR systems can drive documentation efficiency through the implementation of AI scribe programs for clinical documentation. These tools are already integrated into the large inpatient EMRs, and the long-tail of outpatient EMRS needs to match that functionality. However, there are two additional ways that outpatient EMRs can push past just doing clinical documentation: 

1: Coding copilot. Deploy GenAI to automatically fill out claims based on the clinical notes, drawing on the RCM work already done reverse-engineering each payers’ denial algorithm.

2:  Responding to patient messages. Providers like Providence are already using GenAI to pull data from throughout the EMR and other provider systems to draft responses to patient messages for clinicians to review. This functionality can be extended to admin tasks as well, helping with scheduling, troubleshooting bills, and helping admin respond to patient questions faster and with more certainty. 

GenAI is well-positioned to solve processes that are highly manual, draw on disparate data sources, and involve highly complex rules. In other words, RCM.

RCM processes are highly manual. Calling payers to check eligibility, submitting prior auth requests, appealing denied claims…all of these take significant admin staff time.

They also require staff to draw on disparate data. Just to submit a clean claim, providers and billing office staff must draw on: 

• Eligibility data
• Previously used diagnostic codes
• Clinical notes
• Contracted rates
• Payer medical policies

Finally, RCM processes must be adapted to each payer. The eligibility check mechanisms, the formats for 270 eligibility requests, the medical policies governing which diagnostic codes are associated with which procedure codes…all of these vary based on the payer and plan.

Modern Machine Learning (ML) techniques can also be leveraged to create a better rules engine for each payer. 

Additionally, using trained large language models (LLMs) to streamline the process of working through prior authorizations can reduce the administrative burden on practices.

Most outpatient EMRs were not built to easily integrate with 3rd party vendors. They were built for core clinical documentation and added RCM and practice management functionality as they grew.

Yet trying to meet all of outpatient practice’s product functionality requests in-house is a stretch for most outpatient EMR development teams. Without a cloud-native, API forward integration layer, health practices have resorted to building RPA bots to screen-scrape their data out of their EMR. This is frustrating for outpatient practice clients and prevents outpatient EMRs from monetizing potential partnerships.

There is an opportunity for EMRs to make their offering more valuable by building architecture to allow 3rd party vendors to leverage their data and build functionality with the EMR. EPIC is seemingly going to build cloud-native, API-forward architecture to allow 3rd party partners to make their EMRs more valuable. EPIC is also investing further in its partnerships and committing to TEFCA, which allows greater data sharing with non-providers. 

Consider adopting a similar approach by:

• Leveraging cloud-native infrastructure for scalability and flexibility
• Leaning on robust APIs so third-party partners can integrate with your EMR 
• Focusing on initiatives to enhance interoperability through frameworks like TEFCA
  

When it comes to delivering innovation and improving health outcomes, you need a partner who understands healthcare as much as they do technology. At 3Pillar, we work with over 30 healthcare clients to help them bring innovation to the forefront of their operations. Interested in learning more? Discover how we can help you manage through industry transformations.