Health information technology (HIT) has had a tremendous – and mostly positive — impact on our systems for recording, delivering, monitoring, and reporting the healthcare and services we deliver.
Like most of my colleagues, I can tick off at least five or six large “pioneer” corporations – companies like Epic, Cerner, Allscripts, Siemens – in the forefront of the technology explosion that yielded important tools for advancing the field of electronic medical records (EMRs).
Although research into their impact on quality of care and patient safety remains modest and is often controversial, these tools have eliminated considerable issues related to poor physician handwriting and have greatly improved internal and external provider communications and reporting.
The question percolating in my mind has to do with where healthcare is headed and what is being done in the HIT arena to help providers meet the challenges posed by health reform.
Accountability is the chief underpinning of the new models of care promulgated by the Affordable Care Act (e.g., Accountable Care Organizations and Patient-Centered Medical Home) – and it is also an expectation for all healthcare providers and organizations.
Accountability requires a more well-rounded view of quality and efficiency of patient care that takes into account combined clinical, administrative, and financial data.
The problem – EMRs are essentially electronic charts, but what we need going forward is a tool to promote accountability and measurement of quality and safety.
In practical terms, clinicians need an analytic engine that sits on top of the EMR, one that is capable of sweeping up clinical data and converting it to information that will improve clinical decision making.
HIT companies are scrambling to create an “EMR 3.0″ analytic engine for accountability (e.g., an analytic tool that monitors gaps in care for a provider’s population of patients with diabetes), but this is more challenging than it may seem on the surface.
As an “accountable” primary care clinician in the modern healthcare environment, I need:
- A registry to monitor and evaluate my patients – not just individually but as a population
- Relevant data on my patients who share a specific diagnosis such as hypertension or asthma
- Information on how my medical management and patient outcomes compare with other local practices
- Information on where my practice stands in comparison with national benchmarks
Most important, clinicians like me should be able to accomplish these functions easily online.
Now in her third year of medical school, one of my twin daughters has done rotations at three different hospitals, each with a different EMR system. Having grown up using computers, she mastered each of them with ease.
If it takes six clicks of a mouse to access what we need, there is no hope for those of us over the age of 50.
David B. Nash is Founding Dean of the Jefferson School of Population Health at Thomas Jefferson University and blogs at Nash on Health Policy.
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