The increasing use of electronic health record (EHR) technology has been the source of frustration for many physicians, and a point of optimism for health policy leaders. If we as a society are to achieve the triple aim in health care – lower cost, higher quality and improved patient satisfaction – then change is inevitable and technology will be an important part of that evolution.
Change and technology, however, do not come easily to a profession in which practitioners believe autonomy and traditional health care delivery should remain intact. This is surprising considering medicine itself is an ever increasing complexity. Our society has made major advances in longevity and quality of life through scientifically based changes in approach to disease and new technologies in diagnostics and management – all used by health care traditionalists.
For example, the Institute of Medicine recently reported that during much of the 20th century, heart attacks were treated with bed rest. Today, coronary interventions reopen blocked vessels, while pharmaceuticals improve survival and reduce the probability of future heart attacks. There are innumerable other examples of such advances.
The landscape in health care has shifted dramatically in recent years. Today’s physicians are working in a vastly more complex profession. Physicians must not only manage treatment and diagnosis, but they must also be keenly aware of and help address any social, economic and cultural barriers to care that affect their patients.
As a result, health care has become a complex interaction of medical and allied health professionals. The average primary care physician has to coordinate with over 200 physicians and other providers per year. The prevalence of chronic illness and patients with multiple chronic conditions has risen, requiring more coordination and exchange of clinical information to close the gaps in the delivery and management of care.
To the chagrin of many doctors, health care is becoming less of an isolated interaction with a single patient. Medical care, particularly for patients with multiple and complex conditions and responses to treatment, requires exceedingly more integrated and coordinated care within the local health care community using teamwork and communication.
According to the American College of Physicians (ACP), the electronic health record is the cornerstone of clinical documentation and “the primary purpose of clinical documentation should be to support patient care and improve clinical outcomes through enhanced communication.”
Another key ACP recommendation states “as value-based care and accountable care models grow, the primary purpose of the EHR should remain the facilitation of seamless patient care to improve outcomes while contributing to data collection that supports necessary analysis.”
The patient is not to be left out of this process; quite the opposite. The patient must play an active role in his own health care, and information is central to that process. As the ACP suggests, “patient access to progress notes as well as their medical records, may offer a way to improve both patient engagement and quality of care.” An EHR facilitates this.
Nationally, there are about 522 accountable care organizations serving 50 million Medicare beneficiaries, or 17 percent of the Medicare population. These organizations are built on the foundation of communication and the exchange of information. Success in this model is made possible by an infrastructure of coordination and interdependency among physicians, hospitals and other providers, and the adoption and implementation of electronic health technology.
In our community, Catholic Medical Partners-Accountable Care effectively reduced health care expenditures for 28,000 Medicare patients by 7 percent, saving more than $27 million, while also demonstrating high levels of quality in areas including patient safety, care coordination, preventive health and care for at-risk populations. The formula works.
The government mandate and financial support moved most physicians into an EHR quickly. The perception and feeling by physicians that this EHR blitz feels like an attack from the government and insurance companies cannot be denied. It is also true that some abuse the EHR with inappropriate use for financial gain, while reviewers of these records practice a “gotcha” mentality that harasses well-intentioned professionals about their EHR documentation. But the issues and challenges of EHR technology implementation should not prompt the abandonment of the project itself, nor delay its expansion while one awaits the perfect system.
Today’s newly minted physicians would not conceive of documentation without computers. Likewise, these physicians are being trained as members of a team, all of whom rely on each other’s input with the ability to extract the necessary data for crucial clinical and treatment decisions about individual patients as well as the entire population they serve. There is no other option than to expand the digitization of medical care.
In its report, the ACP quoted Sir William Osler, who, over 100 years ago, stated “observe, record, tabulate and communicate.” In 2015, this important charge has not changed, only the method of doing so.
Andrew W. Green, M.D., is a member of Catholic Medical Partners and is board certified by the American Board of Internal Medicine and the American Board of Allergy and Immunology. Dennis R. Horrigan is president and CEO of Catholic Medical Partners.