The Intersection of Patient-Centered Records and Electronic Health Records and Implications for Chronic Disease Management in America

Care at a Crossroads

Guyla C. EvansHIMA 5060

Fall 2012

Contributing causes: Complexity of scientific knowledge

that practitioners need to manage Increased numbers of patients with

chronic conditions Poorly-organized delivery systems Constraints on leveraging

information technology to mitigate the preceding circumstances

A Crisis of Quality

Health care in the US falls short of what is desirable

and possible.

--Institute of Medicine,Crossing the Quality Chasm,

2001

Costs of Chronic Disease 100 million people with chronic

conditions $425 billion dollars in direct costs Additional indirect costs in time

lost from work, etc. One fifth of the population

considered “elderly” by 2030, as baby boomers enter the ranks of the aged

Collaboration between the patient and the health care team is essential

Patients need to understand their treatment regimens, and the implications for non-compliance

Patients must buy into their therapeutic regimens and act in their own self-interests, sometimes by performing self-monitoring

Family members or caretakers may be needed to help

Chronic Care is Different

Care that is respectful of and responsive to individual patient preferences needs values

Care that ensures that patient values guide all clinical decisions

A new paradigm:Patient-Centered

Care

Strong sense of individualism Demanding consumers Intolerant of discrimination “Doctor Knows Best” doesn’t fly Greater percentage of singles May be caring for parents Higher risk for certain unhealthy

behaviors

A model that fits the Baby Boomers

Patient Profile Chief Concerns (not complaints!) History of Present Illness

Biomedical perspective Patient’s perspective

Assessment and Plan HOAP, not SOAP

Problem List Biomedical perspective Patient’s perspective

Progress Notes Attending Physician’s Notes on

Teaching Services Hospital Discharge Summary

A patient-centric medical record

About Me My Personal Health Goals My Ongoing Health Activities My Ongoing Action Steps My Challenges and Successes

A patient-centric Care Plan

Using an EHR to support patient-

centric care:

Data types and User Categories

Appointment scheduling Health history Inquiries Diagnostic test results Patient education materials Integration with an EHR

Patient Portals

A new way to listen to the

patient

Government Incentives

Stage 2 Meaningful Use

Patient-centric Care

Patient Portals

EHR’s

Convergence for improved chronic

disease management

Safe, effective care for patients

with chronic disease