Electronic Health Electronic Health Records and Quality Records and Quality in a Physician’s Officein a Physician’s Office

By Wesley Eastridge, M.D.By Wesley Eastridge, M.D.

For SMA Annual Scientific AssemblyFor SMA Annual Scientific Assembly

November 11, 2005November 11, 2005

Disclaimer:Disclaimer:

Owner/partner of Lakes Mercure electronic health record.

Information in this presentation is generic to all electronic health records programs and not specific to any one.

outlineoutline

Discuss current quality initiativesDiscuss current quality initiatives Demonstrate how electronic health Demonstrate how electronic health

records improved my practice of records improved my practice of medicinemedicine

Caution on reckless use of healthcare Caution on reckless use of healthcare informationinformation

Quality is…Quality is…

““The degree to which health services for The degree to which health services for individuals and populations increase the individuals and populations increase the likelihood of desired health outcomes and likelihood of desired health outcomes and are consistent with current professional are consistent with current professional knowledge.”knowledge.”

Something we’d like to measure

Something we’d like to improve

Organizations already profile our practiceOrganizations already profile our practice

Something we don’t want someone else Something we don’t want someone else measuring wrong to penalize us.measuring wrong to penalize us.

. “The duty of a physician is… Rarely to . “The duty of a physician is… Rarely to cure, often to make better and always to cure, often to make better and always to console.” console.”

- A French Physician- A French Physician

morbidity and mortality

No more lost chartsNo more lost charts

Organized problem listOrganized problem list

Less medication errorsLess medication errors

Remote accessRemote access

Weekend AfterthoughtWeekend Afterthought

MemosMemos

Preventive MedicinePreventive Medicine

Guidelines RemindersGuidelines Reminders

Guidelines RemindersGuidelines Reminders

Quality Indicator QueryQuality Indicator Query

Quality Indicator QueryQuality Indicator Query

Total patients: 612

459 within 90 days of last office visit = 75%

341 had a1c <=7, which is 63%

Drug RecallDrug Recall

ReferralsReferrals

Medical ResearchMedical Research

QualityQuality

Into the Future…Into the Future…

Identification TechnologyIdentification Technology

Identification TechnologyIdentification Technology

TN / VA Regional Health Problems

Care Data ExchangeCare Data Exchange

Health Data ExchangeHealth Data Exchange

Goofus Gallant:

Health Data ExchangeHealth Data Exchange

Goofus:

Computer applications cost money and are frustrating to learn.

Health Data ExchangeHealth Data Exchange

Goofus:

Computer applications cost money and are frustrating to learn.

Gallant:

Doctors will order duplicate tests less because they have all the results available to them. The chance of adverse medicine interactions decreases as each prescriber knows the other prescriber’s medicines. Doctors can improve their practice as they get feedback from quality indicators.

Health Data ExchangeHealth Data Exchange

Goofus:

But those quality indicators can be misleading. One could be penalized with poor average blood sugar control indicators if they choose to take care of difficult and non-compliant patients who don’t want to do all the testing and careful schedules tight sugar control requires.

Health Data ExchangeHealth Data Exchange

Goofus:

But those quality indicators can be misleading. One could be penalized with poor average blood sugar control indicators if they choose to take care of difficult and non-compliant patients who don’t want to do all the testing and careful schedules tight sugar control requires.

Gallant:

Any quality tests we begin with will be imperfect, but the physician could be given opportunity to comment on their results, and there will be many indicators developed over time which are validated by larger studies.

Health Data ExchangeHealth Data Exchange

Goofus:

Who is going to want their medical information out on the Internet for all the world to see?

Health Data ExchangeHealth Data Exchange

Goofus:

Who is going to want their medical information out on the Internet for all the world to see?

Gallant:

Not for all the world. We have the technology to effectively restrict that information to only those who should know. We can let the patient see their own data, designate who gets to see it, and revoke permission at will. They can see a log of who has accessed their data as well.

Health Data ExchangeHealth Data Exchange

Goofus:

Big Brother is watching you! The government can use this information to dig up dirt on an opposition politician or an activist or agitator.

Health Data ExchangeHealth Data Exchange

Goofus:

Big Brother is watching you! The government can use this information to dig up dirt on an opposition politician or an activist or agitator.

Gallant:

It’s our responsibility as free citizens to protect our privacy. We have to put safeguards to keep administrators or officials from accessing the data without court orders.

And now, this…And now, this…

Electronic health records are a powerful Electronic health records are a powerful and useful tool for improving our ability to and useful tool for improving our ability to provide quality healthcare to our patients.provide quality healthcare to our patients.

And now, this…And now, this…

Electronic health records are a powerful Electronic health records are a powerful and useful tool for improving our ability to and useful tool for improving our ability to provide quality healthcare to our patients.provide quality healthcare to our patients.

Protection from misuse of information to Protection from misuse of information to the detriment of the patient or the the detriment of the patient or the healthcare provider will require vigilance healthcare provider will require vigilance and diligence.and diligence.