Information Technology Reference
In-Depth Information
approach to care and not consistently caring for patients according to best clinical
practice guidelines. Electronic records, particularly when connected via a health
information exchange, can help contribute new and key tools to clinical practice to
facilitate care outside of the clinic and to use the best, most up to date treatments.
Data from connected EHRs can be brought together to build a registry - an
aggregated database of actionable health information across a practice or a group of
affiliated practices. There the data is most frequently used to identify patients whose
care is not consistent with clinical guidelines and/or the outcomes required to earn
incentive payments under one form or another of pay-for-performance. It is possible
to create and manage a registry as a stand-alone system independent of an electronic
health record and even where no EHR is used. There are commercial products
designed to do this by mining the needed data from claims, health information
exchanges, laboratory test records and other sources. Registry functionality can also
be built into an electronic health record system, so population health management,
the key goal of a registry, is among potential EHR benefits. Over time, I believe
more and more EHR systems will offer this functionality. However, there are clearly
issues with population health management when multiple electronic record systems
are involved across multiple practices. We'll discuss this in more detail and look at
a registry system in the next chapter.
Clinical reminders are a feature built into most modern EHR systems. Unlike
registries, they operate on a patient-by-patient basis. Reminders help assure that dia-
betic patients get an annual hemoglobin a1c determination to measure their level of
control if the practice has set that as a clinical practice guideline. With the increasing
use of the Internet and mobile apps by patients it is predictable that reminders will,
and certainly should, extend beyond things that must be done in the office to those
that the patient can do to improve their outcomes. The reminder alerts could, and
probably should, also go out to the patient in parallel with going to their provider.
Personal health records and patient portals provide an obvious tool for doing this.
Reduced Malpractice: There is at least one study that suggests that providers using
an EHR have a significantly reduced chance of being sued for malpractice. [ 9 ] .
There are other studies that suggest that poorly designed EHR systems can produce
new forms of clinical errors. [ 10 ] One of these errors is failure to notice abnormal
results, a problem which may often be the result of poor user interface design. One
study suggests an interesting solution - also send abnormal results to the patient.
[ 11 ] Again personal health records and patient portals provide an obvious vehicle
for doing this.
Ongoing Challenges
Despite decades of effort there are at least three key challenges to successful imple-
mentation of electronic health records if success is defined to include increased
provider productivity and improved quality of care. These are the optimal way to
collect data from providers, how to use information technology to improve workflow
Search WWH ::




Custom Search