Technology…Reincarnating Healthcare Services

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How to Maximize Your EMR

EMR can handle medical history and follow-up, orders for tests, prescriptions sent electronically, warnings of drug interactions or contraindications, highlighting of out-of-range test levels, and reminders for guideline-based interventions. Such a system also performs the basic functions of patient demographic information, patient problem lists, clinical notes, orders for prescriptions, and the viewing of laboratory and imaging results.

Utility of EHR

  • Problem lists that are searchable and link to previous progress notes on similar problems
  • Future flags and electronic tasking to remind staff what work remains to be done for patients and to prompt their future actions.
  • Instant messaging between team members- streamlines work and helps people work effectively as a team. Help with requesting and tracking referrals.
  • Help with requesting  and tracking referrals -Transmitting referrals electronically and linking them to tests and radiology can end duplication of effort.
  • Help in coordinating care across settings, providers, and time.
  • E-prescribing linked to the EHR, which includes information about how and when patients fill their prescriptions and their experiences using them.
  • Clinical decision support that can link to a patient’s record to help when guidelines offer equivocal advice. Care pathways, clinical guidelines, and protocols set up within the EHR help to care for a broader population of patients.
  • Patient portals that enable two-way communication between patients and providers and give patients more responsibility for their own health.
  • Registry programs linked to scheduling systems, which are essential for tracking no-shows and improving population health.

Confronting the Downsides

An EHR should be able to communicate with other electronic systems seamlessly. Unfortunately, the standards that allow such sharing are still mostly in development phases. Even on a lower level, there are difficulties with today’s technology.

Care Coordination is the Missing Link in EHRs. If one of the key requirements of a high-functioning primary care office is the ability to coordinate care, a necessary tool is IT that allows information exchange. Unfortunately, most EHRs can’t do that.

Electronically generated consult notes from specialists are “burdened with minutiae. If you are going to talk about meaningful use, you have to have the ability to communicate information in an efficient manner. Moreover, an EHR’s output is only as good as the input. The record is only as good as what you or your staff put into it.

  • Using Smartphones and PDAs

A Blackberry can be used for drug information and medical references and to e-mail colleagues. From a remote place one can view a summary sheet on their phone that’s linked to their practice’s EHR. They can communicate at work place just via a touch to an iPhone button that will call the department and send them that summary sheet. They can then go back and use voice-activated dictation to communicate the same. When they goes to work the next day and turns on their computer, that event appears as a chart entry.

  • The Next Step: Social Media

Less common, but perhaps growing in importance. Social media include online communities, blogs, videos, wikis, and other formats for sharing information. For physicians, that means at least becoming familiar with high-quality online Web resources and social networks and referring patients to them or providing a link to them on their Website.

Physicians are reported reading or writing health-related blogs or message boards, participating in health-related chat rooms, posting health content online, and using online patient support groups. Furthermore, many adults now have wireless and mobile access, which draws people into conversations about health. New tools are starting to appear online that help patients manage their own healthcare, such as Google Health (www.google.com/health) and Microsoft’s Healthvault (www.healthvault. com), can link to a patient’s online health record.

  • Establishing Cyber- (or E-) visits

Billable virtual visits are becoming a more normal part of state-of-the-art primary care practice for established patients. The visits are conducted online, usually through secure portals set up as part of the practice’s Website or EHR rather than through unsecured e-mail exchange. HIT uses evidence-based templates for cybervisits. The e-visit programs ask the patient a host of questions. Which enables Physicians to  make a

more educated determination. And because it takes their time, effort, expertise, and risk, they can bill for that cybervisit. But it avoids a patient, to come in to see a physician at the cost of an office visit. It’s a win-win situation.

  • Older Technology Still Viable

Exceptional practices are also figuring out ways to use older technology, such as telephones and faxes, in fresh ways. One strategy is to use automated telephone calling systems to reach out to patients who aren’t coming in for visits or following through on recommendations. The quality of care has improved and the practice has had a nice return on our investment because the percentage of patients who respond create billable services.

IT experts agree that technology is never the entire answer. Results depend on how it is used, and there are always limits.

Learnings:

  • Traditional health records are paper based which are very difficult to organise and record the same, even the chances of losing the records are also high. Reason behind this is the information in such records are scattered and poorly linked with each other.
  • Of all the physicians reported using all or partial EHR systems only a very small subset were using systems comprehensively i.e. making use of their EHR in a fully functional way. Expanding the use of EMR, to various functions that can make the practice more efficient. These changes will expand its capabilities to include scheduling online, offering links on its website to medical information sites, e-mailing online prescriptions to pharmacies instead of faxing them, creating a disease registry, making its patient summary information screen searchable, and adding an electronic encounter form that can generate a summary page for each patient after the appointment. Smartphone applications are making EHRs accessible anywhere and enable them to consult constantly for drug information, medical references and to e-mail colleagues.
  • If we are unable to deliver today’s science and technology, it will be even worse with the innovations in the pipeline.

“Knowing is not enough; we must apply

Willing is not enough; we must do”

  • This creates a thrust for comprehensive and organized IT architecture to support necessary tools viz. EMR, EHR, PHR, etc. This will facilitate shared knowledge and free flow of information which will provide the needed transparency, including the system’s performance on safety, cooperation among clinicians, and patient satisfaction. Such tools will also help in evidence based decision making.

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