Use of electronic medical records a ‘learning curve’ for providers

02/28/2013 11:21 AM

02/28/2013 11:21 AM

Everyone from your pharmacy to your eye doctor is making the switch to electronic medical records in an effort to share information, avoid duplication of tests and get essential medical information during emergencies.

For patients, it means scheduling your own appointments, accessing test results and reviewing your doctor’s instructions.

But for providers, the switch over the last couple of years has come with its share of growing pains.

“Personally, I think the electronic medical record is the most powerful, single change that’s ever occurred in health care because of the breadth of its effect – it affects patients, hospitals, government entities, doctors, everything,” said Joe Davison, family practitioner at West Wichita Family Physicians, chair of the Kansas Health Information Exchange and member of the Wichita Health Information Exchange.

Incentives for change

Part of what’s driving the move to electronic health records (also known as electronic medical records or EMRs) is financial incentives for providers who make the switch and meet a series of federal guidelines.

“Meaningful use” is a set of standards set up by the Centers for Medicare and Medicaid Services so that hospitals and providers can earn incentives for participating and meeting certain criteria.

“The grants are there to, one, help hospitals and doctors move toward integrating health care systems and collecting data and moving toward EMRs, and, two, to offset some of the costs,” Davison said.

The incentive programs pay providers up to $44,000 over five years for the Medicare electronic health records program and up to $63,750 over six years for the Medicaid electronic health records program, according to the federal government.

The guidelines are still rolling out for the different phases of meaningful use, but eventually, the federal government hopes that the changes will encourage participation in the information exchanges and improve the quality of health care.

“Even before meaningful use, physicians in this community were far above the national average in purchasing electronic medical record systems and putting them into their practices,” said Jon Rosell, Medical Society of Sedgwick County executive director. “I think they saw the benefit of being able to enter information and retrieve information and use it to make better quality patient decisions.”

Challenges

Many providers are still learning the nuances of their different systems.

“We are in a learning curve,” Davison said. “If patients go see a doctor and his nose is in the EMR, he’s trying hard to learn the brand-new system. … I’m convinced it will be less and less obtrusive as the doctors and patients and electronic medical records become used to each other.”

One problem with electronic medical records is their inability to tell the “medical story,” or the narrative a patient gives to a physician when telling them about an illness, Davison said.

“The nuances that pertain to that are difficult for an EMR to capture, so what doctors are sometimes left to do is pre-type that information or dictate that … most of the time the doctor loses the message in interpretation.”

Another issue is patient trust. With so much data available so readily, it isn’t hard to see how people can be wary of misuse of their medical information.

“Physicians must agree to a comprehensive, steep set of expectations to be able to access the exchange,” Rosell said.

“If there’s a breach – unlike paper files – I could pull a chart, look through it, makes copies of notes and walk back, with no knowledge of violating confidence. With EMRs, there’s an audit trail in place to verify information is appropriately used.”

Information exchanges

The biggest issue among different electronic medical record systems is their inability to communicate with each other.

“We all bought different computer systems based on what we thought was best for our practices, whether we are a surgeon family practitioner or neurologist, not really thinking the next step ahead with ‘How are all of these computer systems going to communicate?’ ” said Bart Grelinger, neurologist at Neurology Consultants of Kansas and president of the Medical Society of Sedgwick County.

Kansas is a leader among connecting electronic health record systems, Grelinger said.

Several exchanges are connecting providers across the state, and even into other states, allowing different systems in doctors’ offices to “talk” with each other.

The acronyms for the exchanges can be overwhelming: KHIN, LACIE, WHIE.

“You would think with all the computers and information we have we should be able to trade medical information like stock tips, and it’s just not there for a whole variety of reasons,” Grelinger said.

“When that comes to pass, I think our ability to trade information and get the right information at the right point of service at the right point in time will cut the cost of medicine by a third, but we’re nowhere connected enough to have that happen yet.”

Oftentimes to save time, Grelinger said, providers will repeat tests to get results faster than waiting on the information from other providers.

With the exchanges, providers can share results right away, saving time and money. The exchanges would also allow for providers to stop asking for things like family history at every visit.

“We’re years away from that, unfortunately,” Grelinger said.

Eventually, providers will be able to look at community health and manage health care from a population level, Rosell said.

“That’s where I get giddy about the potential benefits of electronic medical records and the health information exchange,” Rosell said.

At that point, providers and health care systems will be able to data mine and learn from other people’s experiences, Grelinger said.

“The roads aren’t there yet, but we can see where we’re going,” Grelinger said.

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