Most of us have come to accept that an electronic health records system can make life a little easier. You can recycle all of those paper charts, save a fortune on filing cabinets, and free up all that office space you’ve been using to store paper records. Practices with multiple offices can even access patient information from every location.
But in the words of the old Peggy Lee song, “Is that all there is?”
A number of practices are starting to ask themselves that very question. With the high price tag of many EHR systems, practices want more than just a paperless office and instant access. They want to see a genuine return on their EHR investment, in terms of dollars and in terms of better patient outcomes.
So, can an EHR make you a better doctor?
Electronic patient management
Southeast Texas Medical Associates is a multispecialty practice founded in 1995. Headquartered in Beaumont, Texas, and with three offices, SETMA was an early adopter of EHR technology. They implemented their first EHR in January of 1999, and by May of that year a light bulb went off.
“I suddenly realized that we had spent a lot of money and gone to a lot of effort and were still going through a lot of pain to accomplish something that had little value,” says CEO and founding partner James L. Holly, MD.
What the practice needed was not electronic patient records but electronic patient management.
“Our EHR was merely an electronic means of doing what we used to do by paper or by Dictaphone,” explains Holly. “We suddenly realized that the complexities of 21st-century medicine could not be done with 19th-century methodologies, like pen and paper, or 20th-century methodologies, like Dictaphone and transcription. In the 21st century we needed to have electronic methodologies to accomplish the many different things that we needed to do.”
Over the next few years, the practice customized their EHR to create different disease management tools. Their “digital dashboards” address areas such as diabetes, hypertension, and dyslipidemia, and allow them to review quality of care benchmarks for patients with these diseases. Not only can the practice physicians and staff compare the clinical values of individual patients to national quality indicators and standards of care, they can compare the progress of individual patients to other patients within the practice. And they can look within groups of patients (e.g., all patients with diabetes) to gauge the overall quality of care for a specific population.
It’s been a fundamental shift in the way the practice delivers care, allowing them to look at the health of patients on a very high level and target specific ways the practice can improve outcomes. Over time SETMA has been able to use their EHR to not only track their own progress but see what initiatives have had the most impact. By tracking the average levels of HbA1c in their diabetic population, for example, they saw significant drops during the year when they implemented a diabetes self-management education program, and again when they recruited an endocrinologist for the practice.
That kind of data collection allowed SETMA to reallocate their practice’s resources to maximize their return on investment. And it revealed a measurable improvement in patient care that would otherwise have been invisible or impossible to track.
“You can’t do that without data,” says Holly. “An EHR that is robustly used begins to expand and deepen, focus and sharpen, and strengthen the quality of care that’s being given.”
Let the EHR be your elephant
Nearly every practice interviewed cited this data-driven approach to care as critical in improving patient outcomes. Like SETMA, Village Health Partners, a 10-provider family practice in Plano, Texas, has made significant investments in technology — and reaped significant quality-of-care rewards.
To cite just one example, Village Health incorporated mammogram tracking into its EHR and now has 63 percent of the eligible population getting tested regularly. Some physicians in the practice have even achieved an 85 percent level of compliance.
“If you consider the fact that we don’t provide mammograms in our office, that’s an absolutely amazing figure,” says president and family physician Christopher Crow.
Other practices have been equally successful: incorporating colonoscopy measurements, cholesterol testing, blood pressure monitoring, and any number of tests and indicators that are important contributors to future positive outcomes.
The secret? Not having to remember everything.
“We can address the clinical care and wellness and disease management gaps, because the EHR is a database that has information, and it will cue you when things are missing,” says Crow.