Currently, many claim that health information technology and electronic medical record systems are designed around billing and documentation and not around improving the outcomes that matter to patients. And while these systems have the potential to help make care delivery better and easier, as a whole we have not yet truly leveraged these tools in positive ways. Just like we need to prioritize the measures of outcomes that matter to patients, we also need to ensure the health technology systems work to better the patient experience and increase value.
First, electronic medical records should allow for much easier and more powerful data analytics, allowing more insightful investigations of outcomes and cost results.
As Dr. Atul Butte, inaugural Director of the Institute of Computational Health Sciences at the University of California San Francisco (UCSF) explained in a TEDx talk:
“Frozen data is useless data. We have got to let data flow!”
Allowing data to flow not just within, but out of health care systems could enhance population health and allow for rapid review of the care and outcomes for a panel of patients, or a defined group. This is key to developing a health care practice that delivers value for patients and continually improves upon results.
Second, electronic medical records have the potential to automate tasks, such as verifying a patient’s list of current prescriptions, and promote shared decision-making and care coordination. Imagine if the electronic medical record had the level of personalized functionality of consumer products, as with Amazon. It could then deliver resources in real-time, such as the most useful shared decision-making tool or visualization when discussing a specific topic. It could provide robust clinical decision support systems that encourage best practices, reducing unwarranted variations in care. It could also potentially give detailed out-of-pocket cost information based on a patient’s specific insurance plan, helping patients and clinicians choose the best, most cost-effective option for each patient.
Third, health information technology can increase access for patients. For instance, patients can view their own results and records through patient portals, and can contact their primary care team through email or text messaging. 2
Finally, it can enhance communication between primary care physicians and specialists, allowing for more efficient consultations for patients:
In 2012, University of California San Francisco (UCSF) began an “eConsult” program that allowed primary care physicians to send electronic messages to specialists within the system about a patient and receive an answer within 72 hours. The program is based on a specific platform that includes problem-specific templates with built-in clinical decision support developed by participating specialists. Many consult questions do not require an in-person evaluation of the patient – such as general questions about appropriate next steps in work-up or management in lower clinical complexity situations. In these cases, eConsult avoids unnecessary appointments, which additionally opens up precious specialist appointments for others who truly need them. According to UCSF, following introduction of the program, the proportion of patients who received specialty care within 14 days improved from 29% to 46% (in-person visits improved from 29% to 35%). In addition, a standard new patient referral visit costs $232 to $285, while the cost of an eConsult was about $57.1,2
“We have a number of complex patients in the UC system, and the coordination of multiple specialists is a well-recognized challenge. For the right clinical question, an eConsult greatly simplifies the experience of care for the patient, averting the need to farrange time off from work, child care, travel, parking and the costs associated with those.”
The eConsult program is just one example of how to capitalize on the the untapped potential of our current health care information technology systems. Further leveraging these systems will be essential in the movement to value-based care.
ARTICLE
Read this article about the using health information technology to forward the aims of increasing care value and population health.
Harpreet S. Sood, M.D., David Bates, M.D.m, Aziz Sheikh
The Commonwealth Fund Blog, Jan. 5, 2016