Meaningful Metrics: The Patient Experience & the Baseline

James Ralston, Associate Investigator, Group Health Research Institute, Seattle

A pair of recent Health Affairs studies offer some interesting insight: First, EMR adoption is farther along than you might expect, and many of those EMRs already meet a significant number of the criteria for meaningful use. Second, looking to the future, patients could have more of a say in EMRs.

Seth Hogan, survey director, and Stephanie Kissam, health research associate with RTI International in Chicago, surveyed 485 primary care physicians and specialists who use a basic EMR. Hogan and Kissam found that between 75 percent and 85 percent of those surveyed are already using functions that meet some of the proposed criteria for demonstrating meaningful use of EMRs.

“We have a partial picture on how physicians are using EMRs,” says Kissam. “According to our data, primary care physicians [who] have the capability of EMR functions report that they use them quite regularly. It is really encouraging [that] there’s a baseline of people using EMRs who can possibly help others and can work on quality improvements.”

For example, 80 percent of responding primary care physicians whose EMR systems had warnings for drug-to-drug interactions used this function.  In terms of information exchange, 81 percent of responding primary care physicians reported that they sent prescriptions electronically some or all of the time for “at least 75 percent of all permissible prescriptions transmitted electronically.” 

However, “very few physicians that actually had the functionality to send information to public health agency or the ability for patients to view their medical record online reported that use,” says Kissam. According to the data, only 26 percent said that patients could view their medical records online, which would be one potential way to meet the meaningful use measure of providing “at least 10 percent of unique patients with timely electronic access to their health information.”

Kissam is not surprised that few primary care physicians reported use because different policy guidelines were present in 2007, when the survey began. “The policy definitely pushes the technology, where two years ago, the policy wasn’t there,” she says.

This arena of research is necessary to provide a baseline measure of using EMR functions to see how they affect quality outcomes, to know if or how EMRs are supporting quality improvement, says Kissam.

The patient perspective

One potential measure could be the patient experience, says James Ralston, associate investigator with the Group Health Research Institute, Group Health Cooperative in Seattle, and colleagues, who say there’s a need to measure the patient experience as part of meaningful use and to enact policies supporting online and phone communication by patients and providers.

By August 2009, six years after the Group Health Cooperative introduced secure electronic messaging, 30 percent of primary care “encounters” were conducted through secure electronic messaging, Ralston’s study found.

Group Health, a consumer-governed, regional integrated delivery system (IDS) serving Washington State and northern Idaho, has more than 350,000 members. The IDS includes 26 medical centers and 874 Group Health physicians. Group Health invested more than $40 million in 2003 to implement an EMR as part of a larger effort to improve access, empower patients and support care between offices, the researchers reported.

“More and more patients are engaging with the EMR, especially in large health systems,” says Ralston. Study data showed that each month, 10 percent of enrollees reviewed medical test results online and 10 percent went online to request medication refills. “When you set up those services, you set up a patient experience,” he says.

“Patients want access to key portions of their EMR and they want it to be a part of their relationship with their doctor,” Ralston says. “It’s important to view that electronic access in the context of their overall access to care.”

“The right EMR is a great platform,” Ralston says, “and our research so far suggests that it engages patients in meaningful ways and it gives patients and providers the right way to choose to communicate, whether in person over the phone or online.”