EMR Integration Gives Physicians Holistic View, Improves Patient Care

The healthcare industry is in the midst of radical transformation, and health IT is at the center of the revolution—with good reason. At the heart of patient care is the critical information that comprises medical records.

An effective EHR system is just the start of a long journey for most physicians. To create a full continuum of care, physicians’ offices will need to connect their EHR systems with outside sources of patient information—laboratories, other clinicians using the same or different EHRs, immunization and public health registries, and of most urgency, local hospitals.

Unity Hospital, in Rochester, N.Y., is pioneering this collaborative concept as part of the Community Diabetes Collaborative (CDC), with the goal of extending into other disciplines. This approach is meant to improve care along the continuum while engaging the patient in his or her care by giving providing access to his or her records and doctors.

Diabetics benefit from this approach since they interact with multiple doctors and can often end up with complications that require hospitalization or long-term care.

The hospital is integrating physicians and specialists in their network with various digital tools. As part of the EHR system, the following initiatives  help diabetic patients and their doctors be more proactive in their care:

• Analytical tools evaluating the EHR system data identify gaps in care for patients. When due for a visit to an ophthalmologist, for example, a reminder message is sent to the patient.
• Collaborative diabetes protocols, built as electronic templates in the EHR, assist the care team by sharing patient self-management suggestions and educational goals. Patients can download home glucose monitor readings at physicians’ offices and grocery store kiosks for evaluation of blood glucose control.
• A care manager guides patient care. This manager has access to the patient’s records and can access a dashboard that details recent lab results, upcoming medical needs and the current course of treatment.  
• Through a portal, patients have an electronic touch point with their physician to create a working relationship for ongoing care, including sharing medical records and lab results, access to educational materials and appointment requests.
• To ensure access to all documents pertinent to the patient’s care, the CDC guides patients to specialists in their EHR collaborative. A referral management system helps with the initial referral, and creates a dialogue for sharing information after a visit.
• Unity Hospital has connected to the Rochester Regional Health Information Organization (RHIO) database, which serves as a hub for all activity. With patient consent, data are shared with the RHIO, allowing for easier communication between Unity and external, regional physicians and hospitals.

The hospital is not immune to the issues facing primary care physicians as this digital revolution takes hold. The cost of implementing this technology can be daunting, with a lag on return on investment. In addition, the amount of information funneled to the physician, such as lab results, specialist notes and ER visit notes, can become overwhelming and begs the question of responsibility for communicating with the patient. While this is a work in progress, the hospital keeps its sights set on the key objective—better patient care.


Margaret Ann Donahue, MD, is CMIO and a family physician with Unity Health System in Rochester, N.Y.