AIM: EHR reminders, panel management power elderly primary care
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Timothy S. Loo, MD, of the department of general medicine at Beth Israel Deaconess Medical Center in Boston, and colleagues conducted a controlled trial to assess the effectiveness of EMR reminders on healthcare proxy designation, osteoporosis screening, influenza and pneumococcal vaccinations in patients older than 65 years.
The Beth Israel Deaconess general medicine and primary care division has 55 faculty primary care physicians practicing in two separate locations within an urban academic medical center. Both offices use the same EMR. All practicing faculty physicians were invited and all consented to participate.
Analyzed upon completion of recommended practices during a one-year period from May 1, 2009, to May 1, 2010, physicians were assigned to one of the three groups: EMR reminder, EMR reminder plus panel manager or control.
“Among patients who had not already received the recommended care, healthcare proxy was designated in 6.5 percent of patients in the control arm, 8.8 percent of the EMR reminder arm and 19.7 percent of the EMR reminder plus panel manager arm,” the authors found. Compared with the control arm, differences in performance were statistically significant for the EMR reminder plus panel manager but not for the EMR reminder group. “The EMR reminder plus panel manager achieved statistically higher rates of performance than the EMR reminder alone,” Loo and colleagues added.
Bone density screening was completed in 17.7 percent of patients in the control arm, 19.7 percent of the EMR reminder arm and 30.5 percent of the EMR reminder plus panel manager arm, the researchers found. Similar to healthcare proxy designation, differences in performance were statistically significant for the EMR reminder plus panel manager arm compared with the control arm but not for the EMR reminder alone.
Pneumococcal vaccine was given to 13.1 percent of patients in the control arm, 19.5 percent of the EMR reminder arm and 25.6 percent of the EMR reminder plus panel manager arm. “Influenza vaccine was given to 46.8 percent of patients in the control arm, 56.5 percent of the EMR reminder arm and 59.7 percent of the EMR reminder plus panel manager arm,” the authors stated. However, the difference in performance between the EMR reminder plus panel manager and the EMR reminder alone was not statistically significant, they noted.
“Our results suggest that EMR reminders and panel management are effective when they assist physicians without adding significant burden to their workload,” the authors stated. According to the researchers, an e-mail survey of faculty conducted midway through the study found one of the most frequently cited barriers to using EMR reminders was that they would add additional time to the clinic visit.
“These results suggest a 2-tiered approach with point-of-care EMR reminders for tasks completed with nominal effort and panel management for tasks that are more time and effort intensive,” the researchers concluded. “Our results support the concept that team-based care using electronic registries and work lists is more likely to successfully deliver recommended care than individual primary care physicians working on their own.”
In-reach on future’s horizon
Under healthcare reform, demand for services is likely to increase as the uninsured gain coverage. “Given the already strained supply of primary care practitioners, it will be critical to use panel managers and other team approaches to extend the reach of primary care practitioners,” Ellen H. Chen, MD, and Thomas S. Bodenheimer, MD, MPH, from the department of family and community medicine, University of California, San Francisco, wrote in a commentary.
In-reach panel management addresses care gaps in preventive or chronic condition services while the patient is physically in the practice. This requires that all medical assistants be trained to provide panel management to the patients empanelled to the team in which they are working, Chen and Bodenhaimer wrote. “This means that the primary care practice must initiate widespread training on basic preventive and chronic condition care and role redefinition. Moreover, personnel engaged in panel management need interpersonal skills in health coaching to explain procedures, engage patients in a culturally and linguistically concordant manner and assist patients in navigating healthcare institutions.
“Panel management may play a particularly effective role in decreasing healthcare disparities for low-literacy, lower socioeconomic-level, limited English–proficient, and underserved racial and ethnic groups,” the two opined.