HIMSS named its 2011 winners of the HIMSS Davies Awards of Excellence, and Larry Garber, MD, Medical Director for Informatics, Reliant Medical Group (formerly the Fallon Clinic), shares his thoughts on the value of health IT in the following post. Reliant Medical Group won the HIMSS Ambulatory Care Davies Award this year, and I know you will find his insights an inspiring success story on how health IT improved patient care in this medical practice. Jonathan French, HIMSS Director, Health Information Systems
by Larry Garber, MD, Medical Director for Informatics Reliant Medical Group (formerly known as Fallon Clinic)
Throughout the country, health information technology is being implemented at a rapidly accelerating rate, in part driven by the desire to receive CMS’ meaningful use incentive payments. However, for those like Reliant Medical Group (formerly known as Fallon Clinic) that have had the time to go above and beyond the meaningful use incentive payments, the rewards are much broader.
Creative and pervasive implementation of electronic health records and health information exchanges have yielded what I call the 5 C’s:
• Communication enhancements,
• Convenience,
• Competence,
• Confidence, and
• Cost-effective care.
Communication Enhancements: EHRs and HIEs are all about improving communication. At Reliant Medical Group, our EHR automatically routes copies of consult and procedure notes to the referring physician, regardless of whether they are one of our physicians or a community physician. Similarly, we automatically route discharge summaries and ER notes from an interfaced hospital to the EHR InBasket of the primary care physician.
We also provide medico-logical templates that structure nurse telephone triage notes so that they are more meaningful to physicians. We use similar questionnaires with branching logic to gather problem-specific histories from our patients who use our tethered personal health record online from home. We use the PHR to communicate test results automatically to our patients shortly after they are available to our physicians.
To further enhance communication with patients, we strategically place computer monitors in the exam room, so that both the physician and patient see them simultaneously. This, along with graphing capabilities of the EHR and PHR, promotes better comprehension of test results as well as validation of data in the EHR.
In all, communication among physicians, staff and patients is greatly improved with health IT.
Convenience: Just as the internet has allowed us to get information or buy something when we want or need to, EHRs and PHRs allow physicians and patients access to the healthcare system wherever and when they want.
Patients can find information, ask questions, request medication renewals, and even, book appointments on physician schedules online from home at night or over the weekend, when it’s convenient for them. Similarly, many physicians go home early to spend evenings with their family and then go online, when their kids are in bed, to finish their EHR work.
Competence: Throughout the healthcare system, physicians, nurses, medical assistants, technicians, secretaries and patients are making decisions. Health IT allows them all access to the necessary information in a meaningful format, augmented by decision-support tools, so that they can consistently make evidence-based decisions. We are able to make higher quality, safer decisions because of EHRs, PHRs and HIEs.
Confidence: Making good decisions is only half the game. Those decisions translate into orders that need execution. EHRs are able to track these orders to facilitate their completion. Worklists make sure that tests get scheduled, and automated IVR phone systems call patients to remind them of upcoming appointments and tests. Automated systems send letters to patients that miss their tests or appointments. Reports identify patients whose orders still didn’t get completed.
The EHR also automatically sends letters to patients on their birthday reminding them of tests and procedures that each specifically is overdue for. EHR-integrated registries identify patients who, despite all of these efforts, are still are falling through the cracks. We even have the EHR automatically notify the PCP’s appointment secretary three days after a hospital discharge, if a hospital follow-up appointment hasn’t been scheduled.
Health IT allows me, as a practicing internist, to feel confident that my orders are executed, and for my patients to feel confident that they are receiving the best healthcare possible.
Cost-Effective Care: When you know everything about your patient, good decisions result in fewer unnecessary tests, hospitalizations and expensive adverse events. HIEs mean that my staff don’t have to waste time calling to find reports for me. EHRs mean that no one is transporting, sorting or filing paper.
EHRs also streamline other processes that make physicians more efficient. They allow their staff to easily do some of the work that physicians had to do in the past, such as gather recent test results and appointment information, as well as fill in the medication information, at the time of a prescription renewal.
Similarly, we have medical assistants start the visit note for our physicians. Saving physician time means saving money. And in the long-run, all of these savings also reduce the total cost of healthcare.
The True Value of Health Information Technology: As all communities in the country implement EHRs, PHRs and HIEs, and as they move through Stage 2 and 3 of meaningful use, they will realize the 5 C’s, and truly improve the quality, safety and efficiency of healthcare while improving their patient service, just like we have done at Reliant Medical Group.
Contact Dr. Lawrence Garber at Lawrence.Garber@ReliantMedicalGroup.org
