Using EHRs to Improve Patient Outcomes
Healthcare Informatics: How were you initially trained on the hospital's electronic health record (EHR) system?
Manisha Gupta, M.D.: Denton was a beta testing site for T-System [supplied by T-System, Inc., Dallas, Texas], so there was a working EHR from the time I got there. T-System was originally a paper chart and one that I had used in my residency, so I was already very familiar with it. But once I got on-site, I played around with the computer version for about a day and then started using it with patients.
HCI: What was your initial reaction to using EHRs in the clinical setting?
Gupta: I thought it was awesome. It's fast, it's very clear, and it creates a chart that anyone can understand right away. Not only can it do these things, but it also logs all previous patient visits so you can look back and see what tests may have been done and what the patient was presented with then. It gives me a very fast and very comprehensive look at what might be going on with a given patient.
HCI: In the fast-paced environment of the ER, how do you juggle the system and the patient during an exam?
Gupta: I don't use the EHR when I'm with a patient. I see the patient, and once we're done I go back to my desk and chart the encounter there. I need the ability to go into the exam room and have a one-on-one interaction with the patient, look in their eyes, talk to them, and do my exam. Then I'll put the information in the system. For me, doing it this way is a lot faster.
HCI: Have patients had any concerns about the use of EHRs?
Gupta: The most complaints have come from our drug-seekers. They hate the system because we can see they've popped around to different hospitals asking for Lortab. That's where I've noticed the most patient dissatisfaction. Most of our other patients understand that we use computers for everything now and don't seem concerned about it.
HCI: Are there any examples when EHRs has helped you to better diagnose a patient?
Gupta: I could give you lots of examples. To start, depending on how sick a patient is, they might not be able to tell us that they came to the hospital a few days before. We can look into their record and see what tests were done so we don't have to repeat them, which diagnoses were ruled out so we don't waste time there, and what kind of treatment was given. Having that not only saves time, but saves lives. One specific example was a patient who came in with a headache. I saw on the EHR that she had been treated after a car accident at a different hospital a couple of weeks earlier. She hadn't told me about the car accident-patients don't always know what to tell you when they come in. But with the EHR, I could see she had already had a negative CT scan on a previous visit and set her right up for an MRI. I was able to then quickly diagnose her with cavernous sinus thrombosis and get her the help she needed.
HCI: What would you like to see EHRs do in the future?
Gupta: It's a challenge, but I'd like to have the ability to pass patient records between different systems. I can get all the records from within my hospital system, but they are not the only healthcare providers in this area. There are other hospitals, other doctors. Right now, we can't access that information, and it would be nice to do that. It would certainly serve the patients better if we could do that.
The most complaints about EHRs have come from our drug seekers…(who) have popped around to different hospitals. - Manisha Gupta, M.D.
HCI: What would you tell physicians who are concerned that EHR use may negatively impact their practice?
Gupta: Denton, as a beta tester, had been using EHRs for years before they rolled it out to partner sites. There was resistance from doctors who thought it would slow them down and who weren't as accustomed to using computers. But, in the end, by taking the time to learn the system, they realized that using them can really improve your practice. And, just as importantly, by giving you access to past visits and health information, using EHRs can definitely improve your outcomes.
EHR Implementation Bucking Earlier Trends
Four-fifths of the nation's hospitals and 41 percent of office-based physicians currently intend to take advantage of federal incentive payments for adoption and meaningful use of certified electronic health records (EHR) technology, according to survey data released by the Office of the National Coordination for Health Information Technology (ONC). The survey information was released in a press release dated January 13, 2011, by the U.S. Department of Health & Human Services (HHS), at the same time that the Medicare and Medicaid EHR Incentive Programs registration period opened.
Dr. David Blumenthal, the national coordinator, said the survey numbers represent a reversal of the low interest in EHR adoption in previous years. “For years, we've known that EHRs would improve care for patients and bring about greater cost effectiveness in our healthcare sector, yet adoption rates by healthcare providers remained low. I believe we are seeing the tide turn toward widespread and accelerating adoption and use of health IT.”
The data released came from surveys commissioned by ONC and carried out by the American Hospital Association (AHA) and the National Center for Health Statistics (NCHS), an agency of HHS' Centers for Disease Control and Prevention.
The AHA survey found that 81 percent of hospitals plan to achieve meaningful use of EHRs and take advantage of incentive payments. About two-thirds of hospitals (65 percent) responded that they will enroll during Stage 1 of the Incentive Programs, sometime during 2011 to 2012.
The NCHS survey found that 41 percent of office-based physicians are currently planning to achieve meaningful use of certified EHR technology and take advantage of the incentive payments. Four-fifths of these, or about a third of all office-based physicians (32.4 percent), responded that they will enroll during Stage 1 of the programs. Only 14 percent of respondents said they were not planning to apply for meaningful use incentives.
Additional survey data from NCHS show that significantly increasing numbers of primary care physicians have already adopted a basic EHR, rising by 50 percent from 19.8 percent of primary care physicians in 2008 to 29.6 percent in 2010. Most of these physicians will need to further upgrade their EHR systems or their use of the systems to qualify for meaningful use incentive payments.
High rates of adoption and meaningful use could result in as much as $27 billion in incentive payments over 10 years.
Healthcare Informatics 2011 May;28(5):44-46
