Not Just Recordkeeping: Electronic Medical Records Quicken Services, Reduce Errors and Inform Patients
June 7, 2013
By Kristina Grifantini
|Image courtesy of brach0 on Flickr|
A child has suffered a mild concussion. In one situation, a primary care physician verbally tells the parents what they need to do over the next few weeks and leaves the office to look in a file cabinet for an excused-from-school letter. The papers are misfiled, so after a few minutes without success the physician searches on the computer, again to no avail, before resigning to writing one by hand. The parents return home and already forget some of the instructions.
Compare that experience with one where the primary care physician inputs the child’s medical condition electronically into an existing virtual health record. The physician then hits a button, and the parents receive custom information—including a list of what to do for the concussion, a letter of excusal from school, and educational material on what may be expected.
Many forward-thinking medical practices, including 13 pediatric practices in Massachusetts, are making the second experience a reality by using electronic medical records, or EMRs, to increase efficiency in healthcare.
In lieu of paper files, EMRs can provide patients more comprehensive information and resources for their care. At the same time, online records can aid practitioners in coordinating internal processes, like registrations and referrals. Ultimately, EMRs have the potential to help providers spot trends and bolster preventative medicine practices, delivering healthcare more effectively and ultimately leading to healthier patients. In particular, EMRs can help practices become more like a medical home, a system of coordinated care where physicians accurately and systematically provide patients with integrated, higher-quality services (see below). NICHQ (the National Initiative for Children’s Healthcare Quality) is assisting 13 Massachusetts pediatric practices in becoming medical homes through the CHIPRA Massachusetts Medical Home Initiative, one of several state initiatives under the Children's Health Insurance Program Reauthorization Act grant. As part of the initiative, practices are implementing or improving their EMR systems to better children’s health.
What is a Medical Home?
A medical home aims to be a powerful model of comprehensive continuous care, where a team of providers know the full extent of the patient’s needs and uses care plans, available technologies, and other resources to improve access to and quality of care. A key feature of medical home is the integration of services across primary care providers, hospitals, specialists and other health-related services. This integration helps doctors to better coordinate and manage disease, and focus on prevention. In this model, particularly helpful for those with special or complex healthcare needs, patients are encouraged to be active and advocate for themselves. By adhering to certain guidelines, practices can become certified as medical homes.
Practitioners at Patriot Pediatrics in Bedford says their EMR system, Centricity, is helpful for printing relevant educational information, allergy, problem and medication lists as well as care plans for patients. (Care plans are evolving documents that detail a patient’s needs and next steps. Care plans can be invaluable for assisting patients and referred specialists.)
“The care plan helps us keep the parents involved by working with them to document what their needs are, track what’s been done, what needs to be done, and how it’s going to get done,’ says Holly Brown, RN, at Patriot Pediatrics. “Now we can print out all that information for patients to have in an easy-to-read format, which is especially helpful upon referral.”
Aside from a care plan, the team has designed letter and educational templates for caregivers to give to patients, such as for a concussion or other acute issues. Previously, the practice kept educational materials and handouts in filing cabinets but space was limited and providers needed to take time to search for materials.
“Now there’s a flow that makes it faster for the patient and for us,” says Brown. “The EMR helps us establish a medical home by being able to access information and provide patient resources in a short time. By accessing our records and consult notes from other specialists, as well as generating health forms for patients at the time of the visit, we will provide continuity of care and education.”
Saving time is a big advantage to EMRs. In particular, electronic systems streamline patient referrals, registrations and internal messaging.
“EMRs make it much easier to share information and communicate, even just within the office. If you have a paper chart one person at a time can access it, but within an EMR, multiple people can share a patient’s record simultaneously,” says Angela Beeler, MD, of South County Pediatrics. The practice has three physicians, but is a member of the larger UMass Memorial Health Care system which uses Allscripts, a medical software system that allows practices to create notes or tasks to assign to others, track patients, and fax information directly to a specialist.
The practice has also recently added a label printer that interfaces with the EMR system to automatically print lab specimen labels, so that practitioners no longer have to transcribe label information by hand. This, like other features, saves the providers time while reducing errors, yielding better results for patients.
Another advantage, according to Beeler, is that the system lets colleagues flag instructions to each other, which helps get actions done more quickly. While overall the system has been useful, the team has run into some challenges. “We’d like to have more functionality but it’s expensive to pay for it,” says Beeler. “Plus you need a lot of technical support and not all staff is comfortable with computers. Another big challenge is that a lot of different EMR systems don’t talk to each other.”
How Do You Define a Medical Home?
“A medical home is really grasping the idea of what it means to provide full wraparound services for a patient and their families, and how to do it in the most effective way where it’s one stop for all services.”
—Jacqueline Johnson, MEd, Caring Health Center
“Medical home is coordinated care, not just with specialists but among providers within offices.”
—Angela Beeler, MD, South County Practices
“It’s when a practice as a whole is working with a family to address all of their needs. The family is in the center of it. It’s not just addressing medical concerns, but anything else that can have an impact on health.”
—Holly Brown, RN, Patriot Pediatrics
Larger Trends and Preventative Care
One of the most valuable uses of EMRs is that it has the potential to mine through lots of data to see trends or patterns and help systems make improvements.
“Having the complete medical demographics—like medications, allergies, problems—allows us to track development using growth and flow charts, and share those with specialists,” says Brown. “It’s easier to track, compared to going line-by-line in paper documents.”
And by keeping track of a patient’s history over time, EMRs can help doctors avoid missing opportunities to provide preventative care.
“Before, I had to proactively search for what my patient was behind on. Now, we can flag the chart in the EMR to alert us with a message as we’re seeing the patient that he or she is overdue for something, like a visit or screening. Or the EMR reminds me to ask about a patient’s asthma if we haven’t talked about that in a long time,” says Beeler. “Fewer things fall through the cracks.”
The Caring Health Center, which sees about 50,000 patients a year, is launching an EMR system this summer which will capture patient measures, well child visits, demographic information and insurance type among other information. Through the quality improvement initiative, the Caring Health Center team has discussed with other practices what to anticipate and how to help the staff with the transition to EMRs.
“In terms of the medical home, the EMR will help us figure out how these measures add up so we can begin to gauge where we’re falling short and where we’re doing well. Additionally, we will find gray areas or areas where the patient is not adhering to and help them to receive the most effective support,” says Chief Operating Officer Jacqueline Johnson, MEd. “We’re really excited and think that, over the next year, EMRs will allow us to provide more effective, consistent care.”
Learn more about NICHQ’s work in this area:
- Outgrowing Pediatrics
- Transitioning Into a Patient-Centered Medical Home
- The Power of Collaboration
- Creating a Patient and Family Advisory Council: A Toolkit for Pediatric Practices