I cam across an interesting article on a very important topic that is very relevant in the light of recent discussion and legislation on 'meaningful use' of Electronic Medical Records (aka Electronic Health Records).
It was a survey that involved sixty respondents, including 52 physicians or staff from 26 practices with commercial ambulatory care EMRs in place for at least 2 years, chief medical officers at four EMR vendors, and four national thought leaders. There were 6 major findings:
- EMRs facilitate within-office care coordination, chiefly by providing access to data during patient encounters and through electronic messaging;
- EMRs are less able to support coordination between clinicians and settings, in part due to their design and a lack of standardization of key data elements required for information exchange;
- Managing information overflow from EMRs is a challenge for clinicians;
- Clinicians believe current EMRs cannot adequately capture the medical decision-making process and future care plans to support coordination;
- Realizing EMRs' potential for facilitating coordination requires evolution of practice operational processes;
- Current fee-for-service reimbursement encourages EMR use for documentation of billable events (office visits, procedures) and not of care coordination (which is not a billable activity).
The third goal of 'meaningful use' focuses on improving care coordination by enabling exchange of meaningful clinical information among professional health care team by requiring the EHR to possess the following capabilities and functions:
- Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.
- Perform medication reconciliation at relevant encounters and each transition of care.
- Provide summary care record for each transition of care or referral.
Given the survey findings listed in the earlier part of this blog, I am personally skeptical how many of the current versions of EHR Software solutions can pass the three capability tests (as above). The jury is out and we will better know which EMR / EHR Solutions will effectively meet the goal as far as co-ordination of care is concerned in the next few months.
If any EMR / EHR vendors or current users of EMR / EHR solutions would like to share their understanding, knowledge or perspective on this topic, please feel free to leave a comment.
We will continue exploring different aspects of 'meaningful use' over the next several weeks.