Update on EHRs

Nearly 57% of U.S. office-based physicians by the end of 2011 were using some type of electronic health record (EHR) up from 51% in 2010 and 48% in 2009. About a third of physicians (34%) report that they meet the criteria for a basic electronic health record system and 52% of physicians report that they will apply for meaningful use incentives this year, up from 41% in 2010. This means that giant health care physician networks as well as small independent primary care practices are finally agreeing on full adoption of electronic health records.

http://www.cdc.gov/nchs/data/databriefs/db79.htm

First introduced in the 1960s, the implementation of EHRs has been a long struggle because these systems are time consuming and costly for the overly cautious, over-extended physician who has resisted changing the way patient records are kept. One of the drivers persuading physicians to commit to EHR implementation is the 2009 federal economic stimulus package that stipulates that health care providers who demonstrate meaningful use of certified EHR systems qualify for Medicare and Medicaid incentive payments. The federal government is investing $20 to $30 billion in stimulus money to promote EHRs through a system of 62 regional extension centers. The centers are hosted by a variety of entities from government agencies to non-profit health care consortia. The extensions have been given the formidable task of selling and supporting the switch to EHRs across the country.

An EHR is an electronic version of a patient’s medical history that is maintained by the provider over time and may include all of the key administrative clinical data relevant to that person;s care, including: demographics, progress notes, problems, medications, vital signs, medical history, immunizations, laboratory data and radiology reports. The EHR automates access to this information and has the potential to streamline the clinician’s work flow and make it possible for patients to share this information and thus share in decision making. The EHR also has the ability to support other care-related activities directly or indirectly through various interfaces including evidence-based decision support, quality management and outcomes reporting. The good news is that with an EHR there is no more missing information at the point of care ; no more searching through a paper file to look for the results of a previous test, while the patient is sitting and waiting; no more lost charts. Done correctly, EHRs streamline interactions between all players on the health care front from pharmacies and labs to ambulance crews and insurance companies.

EHRs are also the next step in the continued progress of the health care system to strengthen the relationship between patients and clinicians and enable clinicians to make better decisions and provide better care. For example the EHR can improve patient care by:

• Reducing the incidence of medical error with the improved accuracy and clarity of data.

• Making health information available to patients

• Reducing duplication of tests and delays in treatment.

Blue Cross & Blue Shield of Rhode Island recently announced results of a multi-year pilot program designed to increase the use of electronic records , transform the way health care is delivered, improve members’ health and help moderate health care costs. Results of the pilot which became the foundation of BCBSRI’s patient-centered medical home model demonstrate the value in using health information technology to improve quality of care. Highlights of the pilot include the following:

• Lower monthly health care costs that averaged between 17 and 33 percent less per member than those receiving care at non-participating practices

• Improved health care quality with a 44 percent median rate of improvement in family and children’s health, 35 percent in women’s care and 24 percent in internal medicine

• Successful EHR implementations for 79 local physicians

https://www.bcbsri.com/BCBSRIWeb/about/newsroom/news_releases/2011/QualityCountsNR.jsp

A recent article in the New England Journal of Medicine (December 15, 2011) showed that EHRs improved the quality of care for patients with diabetes by reducing unnecessary testing, helping to prevent adverse events and improving patient care coordination as compared to practices that use paper-based methods.

http://www.nejm.org/doi/full/10.1056/NEJMsa1102519

All of these studies and examples would lead us to believe that the EHR has finally established its worth to the medical community and once we approach 100% participation, patients can be assured that they and their providers will have access to their health information at the point of care. The availability of digital health information will enable patients to use email, portals,. and e-visits to more effectively and efficiently communicate with providers and to use smart phone apps to monitor their health. As a result they will experience better, safer medical care.