HealthAffairs: Patient experience essential to EMR, needed in MU criteria

In addition to the currently proposed measures for clinical quality, meaningful use measures for EHRs should include assessment of a patient’s experiences, according to an article in the April edition of HealthAffairs.

“EHRs that directly engage patients and families represent a platform for improving access to care, empowering patients and supporting care between office visits,” wrote James D. Ralston, MD, associate investigator with the Group Health Research Institute, Group Health Cooperative in Seattle, and colleagues.

Ralston and colleagues performed a retrospective, serial, cross-sectional study of the adoption and use of the Group Health’s patient web site from Sept. 1, 2002 through Dec. 31, 2009 to describe the patterns of use of online services linked to the EHR over time.

According to the article, Group Health, a consumer-governed, regional integrated delivery system serving Washington state and northern Idaho, has more than 350,000 members who receive care through its integrated delivery system, which includes 26 medical centers and 874 Group Health physicians. Group Health invested more than $40 million in 2003 to implement an EHR as part of a larger effort to improve access, empower patients and support care between offices, the researchers reported.

“Prior to the launch of the patient web site, Group Health’s internal surveys found that enrollees’ access to the internet had increased from 24 percent in 1996 to 71 percent in 2000,” the authors wrote.

By August 2003, the web site allowed patients to:

• Exchange secure electronic messages with members of their healthcare team, including primary care and specialist physicians they had visited;
• Get real-time access to portions of their EHR, including laboratory data; problem lists, medications, allergy history and prior immunizations;
• Obtain after-visit summaries with hyperlinks to the Healthwise knowledge base, a comprehensive, searchable health and drug reference library;
• Obtain medication refills with free shipping to their homes; and
• Schedule office appointments with physicians online.

By Dec. 31, 2009, six years after the introduction of those services, 58 percent of the adult enrollee population was registered for access to the online services, according to the report. Analysis found that 30 percent of outpatient encounters were conducted through secure electronic messaging.

Meanwhile, the study found that 10 percent of enrollees reviewed medical test results online and that another 10 percent went online to request medication refills.

Patients' use of EHRs spurred two redesign efforts for Group Health, the article noted. One began in 2002 and sought to assess and increase patient’s engagement with the EHR as part of a broad approach to improving access to care. The second, beginning in 2006, was to create a patient-centered medical home. “Rapid adoption of online services presented a good opportunity to engage patients further in more comprehensive care outside of office visits over the patient web site,” the authors remarked.

“Despite the primary care staffing investments [of the medical home effort], research showed that costs were recouped in the first year largely as a result of reductions in emergency room use,” Ralston and company reported. Based on that initial success, Group Health began spreading the medical home redesign to all twenty-six clinics in 2009.

"Providing strong support for providers to communicate with patients outside of office visits was considered essential to the success of the medical home pilot," the article stated.

“The process of understanding and optimizing the functions of [Group Health’s EMR] system have required ongoing evaluation and practice redesign,” the authors concluded. “For these lessons to be transferred to other EHR implementations, policy makers and organizations should first ensure that patients have appropriate and preferred access to care when and where it is needed.”