I recently had a chance to speak with several primary care physicians about their use of EHRs in the outpatient setting. They said they love that they can retrieve patient data so quickly. In the past, they would have to find the physical chart in a chart room and then thumb through pages of handwritten notes to find the information they were looking for. Now, they have the luxury of a search engine at their fingertips that can quickly look through patient chart information. They can also retrieve this information remotely from home or from
Then, I shifted gears and asked them about their clinical performance and the information that appears on their data dashboards. Did they know how many of their patients with hypertension are currently at a goal blood pressure? Or how many of their patients with diabetes have HbA1c levels that are within national clinical practice guideline standards? They didn't know, so we spent a few minutes manually answering these questions.
Most outpatient EHRs allow patient records to be retrieved based on specific parameters. Many EHRs also let the user mix and match Boolean operators such as "and", "or" and "not" when searching. For example, you can search for patients over the age of 18 who have a hypertension diagnosis and the EHR will respond that 5,000 patients meet those criteria.
Now, you can continue to filter your search by finding those who have a systolic blood pressure that is less than or equal to the goal level of 140. If that search result reveals that you only have 3,500 patients who meet those criteria, then your hypertension performance is effectively 3,500 out of 5,000, or 70%, of patients who meet the goal. That type of information should appear regularly on doctors' data dashboards, but it rarely happens in the private practice world because physicians are too busy keeping up with their clinical duties and trying to treat as many patients as possible.
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If a physician knew that 30% of his patients with hypertension are not at goal levels, it would not take much effort to go through the EHR and identify those patients. The work begins when a physician realizes that some of those patients have not had a checkup in the past year. Those patients need to be sent a reminder to return for blood pressure management. Sending those reminders likely isn't programmed into an EHR, so doing so will fall on your office manager.
Next, even if some of those patients in the 30% were seen recently, it's possible they aren't taking their prescribed medications. Pharmacy-dispensing data is not yet directly linked with most EHRs, so physicians don't have a way of knowing whether their patients filled their prescriptions. If a patient takes multiple medications, they may not know the names of their medications and could forget about a certain pill if they lose that prescription.
Even though the majority of physicians are now using EHRs, the process of caring for patients still heavily relies on a manual process of data collection, searching, filtering, and then expecting that someone will act on that information. Many physicians don't have time to ask self-reflective questions about their own clinical performance. This is why they need a dashboard that provides actionable information along with buttons that will trigger automated communication to patients who need to receive a clinical reminder message.
About the author:
Joseph Kim is a physician technologist who has a passion for leveraging health IT to improve public health. Dr. Kim is the founder of NonClinicalJobs.com and is an active social media specialist. Let us know what you think about the story; email firstname.lastname@example.org or contact @SearchHealthIT on Twitter.
This was first published in October 2013