Today I decided to take a look at one of the dashboards that the information technology (IT) department built for our electronic health record, to help us a look at our patients enrolled in the multiple registries of diseases and conditions we are following for the patient-centered medical home.
I booted up the program, and with just a couple of clicks of the mouse the program began running, checking with the master database to find patients who met the criteria we have prespecified.
So after a few minutes (although I thought it would go faster …) the results spooled out on my desktop. Multiple boxes showing all of my patients with diabetes, and items of interest. Those with a hemoglobin A1c above 9.0. Those with hypercholesterolemia not on a statin. Those with recorded blood pressures out of the recommended range. Ophthalmology, not recently. Foot exam not documented. Vaccines not up to date.
So now what?
What I want to have happen is that these become actionable items, something from which I can do something. Those patients with poorly controlled diabetes? I want a mechanism to intervene. They don’t have an ophthalmology visit documented? How about automatic ability to order an ophthalmology referral placed right from that spreadsheet?
I hover my mouse over the fields, hoping that something will light up, hoping that someone will take me somewhere I want to be. Future-ordering vaccines, hemoglobin A1c’s, anything the patient needs, so that it’s all queued up and ready for them the next time they come. Or even a way to send an electronic reminder that Dr. Pelzman wants them to get A, B, C done the next time they’re here and that all will be ready and waiting for them.
The same holds true of all these reports we get in the mail. Each individual insurer sends us a list of our patients who have been noncompliant with their prescription refills. All of our patients, who according to them, accurate or otherwise, have not had lipid profiles done in the past year, mammogram done in the past year, colonoscopy ever, vaccines overdue.
When I get these in the mail, this is not the time I need to see it, this is not the place to remind me to be a better doctor; if it’s not actionable and it can’t lead to a direct positive outcome for a patient, then it’s almost no use at all.
The dream of HIPAA, its real intentions, and those of the Affordable Care Act, as well as the underlying principles of the patient-centered medical home, is that we should be able to collect, analyze, and have a positive impact on the data that all of a multitude of systems are collecting about our patients. It should be easy, efficient, nonredundant, and not add a lot of extra work for everybody.
We only need to know once that a patient is overdue for some health care maintenance intervention, lab test, medication refill. Collect it, process it, pass it on to the right places, make it actionable, so that all the members of the team know it once, at the right time. Something is missing, something needs doing.
I know there are national and statewide initiatives underway to improve the communication between different electronic health records, to unify things so that what one system calls a data point is the same thing as what another system calls it, and that this will allow us more seamlessly to build systems to let this information flow from one to another. At the moment our IT department tells us this is just not feasible, not yet.
But we can dream.
Fred N. Pelzman is an associate professor of medicine, New York Presbyterian Hospital and associate director, Weill Cornell Internal Medicine Associates, New York City, NY. He blogs at Building the Patient-Centered Medical Home.