Guest Columnist
Improving Healthcare through Electronic Health Records
By
Oct 5, 2009 - 1:58:47 PM

(HealthNewsDigest.com) - Imagine going to your bank branch in Boston to cash a check and the teller tells you to wait until she fetches your account file to verify fund availability and to verify your signature. Or that you are traveling to LA and need to cash a large check, but have to wait until the bank contacts your home branch in Boston to authorize the transaction. Would you continue your account with this bank?

Let’s take a parallel in real life. You visit your physician because you have knee pain. She looks up your records, gets an X-ray done and prescribes some medication. You leave on a trip to LA and find the pain getting worse. You visit a local doctor, but he has no access to your medical history. He could rely on your memory about what tests have been done and the results. He could start over and repeat the tests. He could try to call your home doctor, and ask to have your records faxed over.

We wouldn’t put up with that kind of inefficient information management in financial matters, but it is normal, unfortunately, for health care. Why can’t technology make life better for all of us in all aspectsof life?

For several decades, the healthcare industry has debated the advantages of exploiting information, and how the introduction of technology can help or hinder patient care. Today, it is recognized through growing evidence that technology can play a major role in improving patient care and reducing costs of delivery. Yet the healthcare industry significantly lags behind other industries in adopting information technology. And until the recent past, the adoption of technology has tended to be aimed towards administrative data rather than clinical data. There are a number of explanations for this, including concerns over patient privacy. But with increased security, those concerns are fading – particularly when immediate access to complete health records can ease pain and suffering and even save lives.

With the likely healthcare funding through the introduction of American Recover and Re-investment Act (ARRA), where early adopters are rewarded and laggards are penalized, it is critical that providers adopt IT (for ‘meaningful use,’ of course.) For health and medical information to be meaningful and valued, above all, it should be accurate and relevant. The collection of information should not become a goal in itself; rather it must be non-intrusive and support the clinician. New technology can improve patient safety, reduce cost and allow clinicians to direct their efforts to health care rather than paperwork.

Outlined are some examples of areas where technology can improve the quality of care, based on the proposed healthcare bill as well as our own experience with the implementation of IT applications at the National Health Service in the UK.

Technology in Frontline Services

Computerized physician order entry (CPOE) is a tool to implement the process of ordering medical care. It is an opportunity for providers to ingrain their best practice into the tool that makes it more effective whilst also reducing medical errors. It is a ‘quick win.’ Similarly, Electronic Prescribing or e-Prescribing, is a tool to prescribe drugs that not only capture accurate information, but also warn clinician of harmful drug-to-drug reactions and other complexities. This is a tool for improving patient safety.

Implementation of tools such as CPOE and e-Prescribing lead to the creation of a patient-centric database of medical records (EMR). EMRs can achieve the ultimate outcome of technology: a level of efficiency that allows the clinician to concentrate on patient care, whilst calling up patient information at the click of a button. EMRs can allow the exchange of clinical information – through Health Information Exchanges (HIE) or other channels – enabling patients and doctors to compare and choose care alternatives.

The HIE offers secure and accurate information at the point of care at the moment it is needed – not after phone calls and faxes. The current programme has many sizes and complexities of information exchange, from large public-sponsored exchanges to local private exchanges. There is an opportunity to rationalize on exchanges at regional levels, without the need for multiple licenses and implementation effort. This has the potential to significantly and strategically reduce the current outlay by more than 50%. This will also provide a 360-degree view of every patient since all the records of a particular geographic area will be available in a single electronic record. In the UK, a standards-based messaging hub has been designed to manage all access into the national/regional systems. This messaging hub is then able to centrally deal with all information requests and deliver them to published interfaces.

Technology in Long Term Care

Recent studies have shown that nearly 60% of visits to a physician are caused by a Long Term Condition (LTC) and 60% of the bed use in hospitals is caused by LTC or its complications. A strong stream of evidence suggests that the key to reducing those numbers is to have individual patients take a larger role in managing their health and lifestyles. Technology can play a vital role in empowering individuals to self-manage their LTC. But services need to be more flexible for varying levels of self-management. Professionals need clear, easily accessible information to help individuals develop personal care plans. EMRs can be extended to include personal health information to move the information agenda from providing medical care to promoting well being.

Technology in Operations and Economics

Besides the above, technology can play a crucial role in the management of resources that has a direct and measurable impact on frontline services. Activities such as booking appointments can be made as easy as buying a book from Amazon. In another example, studies have shown that analyzing information has reduced the average length of hospital stay by 30%. Technology can play a pivotal role in this process by automatically highlighting potential areas of improvement. It is a double benefit: improving health outcomes and at the same time freeing up valuable (and expensive) beds and other resources.

With billions of prescriptions issued every year, administrative costs are a huge burden on health care systems. Studies have shown that more efficient use of technology – eliminating paperwork – can save several hundred billion dollars.

Technology in Policy Making

EMRs and EHRs provide an opportunity to make additional use of the wealth of information to ‘self-fund’ initiatives that improve the quality of care and patient experience. These include provider benchmarking, evaluating drug benefits, and measuring new models of care. The UK has been at the forefront of building possibly the world’s largest health data store to support planning, research and policy-making to meet citizens’ health objectives. Systems such as Secondary Uses Services (SUS) and Quality and Management Analysis System (QMAS) have been developed at a national level to enable performance analysis, quality outcomes measurement, and needs assessment.

Conclusion

It is in our interest – all of us – that healthcare service is safe, efficient and productive. Resources must target conditions and diseases that impact human life. More efficient use of information can allow patients to work with healthcare professionals in the decision-making process and empower individuals to take control of their conditions and their own wellbeing.

Mastek (MajescoMastek in the US) provides enterprise IT platforms and solutions for insurance, financial services, healthcare and government verticals. Mastek was a partner to BT in developing key applications for the National Health Service’s central messaging layer and health data warehouse in the UK.

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