ONC: Engaging the patient, improving care through EHRs
A highly functional EHR can facilitate better care by providing complete, accurate and up-to-date information for patients and physicians. But realizing such improvements requires the involvement of physicians who actively engage patients in the information gathering process. So said Peter Basch, MD, medical director of ambulatory EHR and health IT policy at Medstar Health in Maryland, at the Nov. 17 annual meeting of the Office of the National Coordinator (ONC) for Health IT.
“Knowing the patient is fundamental to providing excellent and safe care. That knowing includes making sure that key clinical information is accurate, complete and up-to-date,” said Basch before outlining how the EHR is best used in a typical appointment.
Upon a visit, physicians should ask their patients questions, including any changes in medications, emergency visits or other health information, to input that data into the EHR. “If we don’t know, we certainly want to ask the patient,” he said.
After a medical assistant completes the initial debriefing of the patient, the provider enters the room and reports the patient's history. The EHR presents opportunities by allowing the provider to track potential problems down the road and engaging the patient in their own health decisions. Additionally, it can flag errors or oversights made by the physician.
“With a little bit of additional time and focus, health IT can be successfully integrated into the care process to make prescribing better, safer and less costly,” said Basch. “It’s making it efficient for the provider to instruct the patient in print or through the portal.”
For example, Basch described a scenario where the EHR catches an error. “In this case, the provider mistakenly entered one tablet four times a day, or double the maximum daily dose,” he said. “The system warns us. You’ll see a warning which requires that the dose be corrected, or the provider enter an over-ride.”
Next, Christopher H. Tashjian, MD, a family practitioner at Ellsworth Medical Clinic in rural Wisconsin, demonstrated how the EHR can improve the coordination of care simply by providing the patient with a printed copy of the visit summary.
“We use the after-visit summary as a way of leveling the playing field and making sure they have the information they need,” he said, adding that printers are installed in every exam room so the documents can be printed and handed directly to the patient. “They can print out a copy right then and there without ever getting up or leaving the room. I think it’s vitally important to involve them in their care.”
Not only does this provide an opportunity to engage the patient, but they can also double-check the record. “This gives them a chance to say—and I’ve seen it firsthand—‘Doc, you forgot this one,' or 'I don’t have this problem anymore,'” he said.
While meaningful use requirements have been perceived as a burden by many physicians and healthcare professionals, Bruce D. Greenstein, secretary, Louisiana Department of Health and Hospitals, said that, as “chief complaint-getter” for his state, he knows that many providers are becoming increasingly satisfied with the opportunities EHRs provide.
“I go all over, and I’m meeting with all kinds of providers and patient advocates and everyone loves to complain first. Especially, physicians love to complain about all of the burdens of meaningful use,” he said. “But here’s what I’m also seeing now in the last six months. ‘Let me show you our system and what it does.’”
“Knowing the patient is fundamental to providing excellent and safe care. That knowing includes making sure that key clinical information is accurate, complete and up-to-date,” said Basch before outlining how the EHR is best used in a typical appointment.
Upon a visit, physicians should ask their patients questions, including any changes in medications, emergency visits or other health information, to input that data into the EHR. “If we don’t know, we certainly want to ask the patient,” he said.
After a medical assistant completes the initial debriefing of the patient, the provider enters the room and reports the patient's history. The EHR presents opportunities by allowing the provider to track potential problems down the road and engaging the patient in their own health decisions. Additionally, it can flag errors or oversights made by the physician.
“With a little bit of additional time and focus, health IT can be successfully integrated into the care process to make prescribing better, safer and less costly,” said Basch. “It’s making it efficient for the provider to instruct the patient in print or through the portal.”
For example, Basch described a scenario where the EHR catches an error. “In this case, the provider mistakenly entered one tablet four times a day, or double the maximum daily dose,” he said. “The system warns us. You’ll see a warning which requires that the dose be corrected, or the provider enter an over-ride.”
Next, Christopher H. Tashjian, MD, a family practitioner at Ellsworth Medical Clinic in rural Wisconsin, demonstrated how the EHR can improve the coordination of care simply by providing the patient with a printed copy of the visit summary.
“We use the after-visit summary as a way of leveling the playing field and making sure they have the information they need,” he said, adding that printers are installed in every exam room so the documents can be printed and handed directly to the patient. “They can print out a copy right then and there without ever getting up or leaving the room. I think it’s vitally important to involve them in their care.”
Not only does this provide an opportunity to engage the patient, but they can also double-check the record. “This gives them a chance to say—and I’ve seen it firsthand—‘Doc, you forgot this one,' or 'I don’t have this problem anymore,'” he said.
While meaningful use requirements have been perceived as a burden by many physicians and healthcare professionals, Bruce D. Greenstein, secretary, Louisiana Department of Health and Hospitals, said that, as “chief complaint-getter” for his state, he knows that many providers are becoming increasingly satisfied with the opportunities EHRs provide.
“I go all over, and I’m meeting with all kinds of providers and patient advocates and everyone loves to complain first. Especially, physicians love to complain about all of the burdens of meaningful use,” he said. “But here’s what I’m also seeing now in the last six months. ‘Let me show you our system and what it does.’”