Although healthcare providers are making progress in adopting health IT, Americans seem to be resistant to change to Electronic Health Records (EHRs). In fact, only 26 percent of Americans want their medical records to be digital, according to findings from the third annual EHR online survey of 2,147 U.S. adults, conducted for Xerox by Harris Interactive in May 2012.
Last month the Institute of Medicine issued a seminal report entitled “Best Care at Lower Cost: The Path to Continuously Learning Health in America.” The report estimates the American healthcare system suffered a $750 billion loss in 2009 from inefficient services and administrative expenditures. The report is grounded on the principle that effective, real-time insights for providers and patients which result in collaborative and efficient care depend on the adoption and use of digital records.
As people are naturally resistant to change, education will be key in gaining support among Americans for the transition to EHRs. If providers can help patients understand “what’s in it for me,” that will likely go a long way in making Americans feel more comfortable with the switch to digital.
Let’s take a look at five ways EHRs directly impact the patient. For these examples, we’ll use a fictitious patient named “Joe”:
- Health Information Exchanges (HIE): HIEs work on the principle of a network – they grow stronger as more participants join. If Joe’s primary care doctor switches to digital, that’s a great step in the right direction. However, it isn’t truly meaningful until his primary care doctor joins an HIE and begins sharing Joe’s patient health history, medication history, lab results, family and social history and vital statistics with his specialists, emergency care providers, and so on. This sharing of information helps ensure that Joe gets the best quality of care, because all of his providers will be in sync and have the most up-to-date information. It also helps reduce the amount of duplicate exams and labs Joe will be asked to give.
- E-Prescribing: Instead of handing Joe a prescription on a piece of paper that can be lost, misread or stolen, his provider will send an accurate, error-free and understandable electronic prescription directly from the point of care to the pharmacy – adding to the quality of patient safety and care. Prescribers (who are part of the provider’s HIE) review medications quickly and determine if they meet preapproval criteria while developing a prescription. At the same time, both physicians and pharmacists automatically receive alerts of any potential adverse drug interactions. E-prescribing improves Joe’s satisfaction as the process removes the step of having to drop the prescription order off to be filled – and he has peace of mind that his order is accurate and timely.
- Face-time with caregivers: As more providers adopt digital records and get more comfortable with entering information electronically, processes will naturally become more efficient and simple – freeing caregivers to spend more time on interacting with patients like Joe.
- Predictive analytics: Xerox’s Midas+ Live software continuously searches the information Joe’s caregiver enters into his EHR, and alerts them when any of thousands of possible changes in his condition happen simultaneously – such as an increase in temperature or low blood pressure, combined with various lab and radiology results. This information can then be used to inform Joe’s caregiver prior to a decline in his condition – resulting in an increase in the quality of his care.
- Security: While many Americans are concerned about the security of EHRs (74 percent of survey respondents believe their information could be stolen by a hacker), the fact is they’ve been trusting banks to store their digital records for years in much the same manner. Storage and transmission of information are the two areas someone might try to gain access or intercept someone’s private records. Banks have encryption and authentication methods to secure data and records – for example, when you log into your online bank account, you are directed to a https:// address – the ‘s’ indicates the address is secure. The healthcare industry has similar encryption and authentication methods to govern data security, on top of HIPPA to dictate roles-based rules around access to records.
So, while much of the communication around EHRs has been about how digital records will improve workflow for providers, there are also clear benefits for healthcare consumers. There is a need for better patient-provider communication – until providers start better conveying the benefits of electronic records, it will be difficult to gain support among Americans.
Will Saunders is the group president of government healthcare solutions for Xerox Corporation. This article brought to you by Xerox Corporation .
Magnificent issues altogether, you simply won a logo new reader. What might you recommend in regards to your post that you made a few days in the past? Any positive?
Electronic health records can improve the ability to diagnose diseases and reduce or prevent medical errors, access to good care becomes easier and safer when records can easily be shared.
This is amazing!
Lots of docs do use scribes, but the point is that the only way that EHRs will improve is through them being used on a wide scale and then generating consequent feedback to the vendors. That’s how Web 2.0 works which is why tools are so much better than Enterprise software. And we do need to protest legacy enterprise EMR software. But that war is being won–most of the new iPad tools are really a giant leap ahead–cehck out Allscripts (yes the maligned Allscripts “Wand” pp on the iPad
But staying on paper is not the answer–not matter how much southern doc et all complain.
[snip]…insights for providers and patients…[snip]
Anytime I see the terms providers or payors or institutions, in the same sentence as patients, for me the argument is already lost.
Industry’s vs consumer incentives are completely misaligned. EHR benefits, as noted in almost all IOM reports, flow exclusively to 3-of-4 participants, where consumers are left out.
The fact that only 26% of Americans want a digital health record (read: that benefits others) shows just how smart consumers actually are. Its a scathing indictment of EHRs.
What we consumers want is: PATIENT-CONTROLLED health records.
In court lawyers and judges don’t do the typing (ECR electronic court records) – the court steno does. Maybe it’s time the docs were accompanied by their own record typer?
Exactly. No other profession would put up with that crap. I think the professional typist, paid directly by CMS, is a great idea.
john said: “The EHR will ultimately give you:…”
And that’s really the issue – what the EHR will (or should) ULTIMATELY give you is very different than what the EHR DOES give you.
The PROMISE of health IT in health and healthcare is much greater than what we’re seeing today, for a variety of reasons, some of which have to do with the technology and many of which have to do with our healthcare non-system and the role that patients have (don’t have) in it.
I think this is a good start. But I think we’re going to need to frame this conversation in a way that the average American can understand. I’m not so sure that the HIT language translates that well for the ordinary Americans. (We’re combining three hard to fathom languages here: IT speak, government English and health care jargon. Is it any wonder people’s eyes are glassing over?
Here’s what we should say.
The EHR will ultimately give you:
1. Faster access to your test and lab results.
2. Reminders of what you need to do to manage your care
3. Plain English explanations of what your diagnosis means and access to the literature on what your treatment options are – this should be built into future systems
4. Detailed and easy to understand explanations of your medical bills
5. Information on the medications you are taking / risks and benefits
6. A way to track your progress or lack thereof
7. Other cool stuff people want – maybe we should ask them what they want rather than telling them???
He looks for like Tosh.O
I have used three different EHRs in the last three months.
They all suck. Each record is full of errors.
My skills are not typing. Talk about mistakes! Who thinks there will be fewer mistakes with the physician typing? The pharmacist has always been the safety net for prescribing errors, and the nurse in the hospital is the safety net there. (Until they dumbed them down).
E-prescribing costs the receiving pharmacies money. They hate it. They do not know if the patient will show up or not. to buy the prescription. You cannot Erx narcotics. If you prescribe more than one med you really should not Erx the uncontrolled meds and give a paper rx ro the controlled substance. The patient easily can go to another pharmacy that is unaware of the ohter rxs and only buy the narc.
Quit relying on the virtues of the patient. Relying on welfare recipients to not want to be on welfare is what sunk those programs (they never wanted to get off once they were on.)
So RBAER –
@ HIPAA – Does any sane person think HIPAA – a law that was developed before the Internet had even really started gathering steam – is the answer to anything??
@ false positives – let’s get test results first for people who aren’t getting them. And then worry about false results. But you’re right, a fix is going to be needed here.
Will’s resemblance to Jim Carrey is in fact pretty damn amusing – hahaha
We are, IMHO, already getting way too many false positives and patients who have coverage tend to be overtreated, often by a lot. I don’t know this software, but from what I understand from the summary, it gives you some kind of warning based on composite parameters. As long as this is not of proven value, we don’t need to add another source for overdiagnoses and overtreatment.
Re. HIPAA – it’s not at all the answer to everything, but it is a real existing obstacle (not an impenetrable one) to data exchange. I would be in favor of legislation that assures that every health care provider who is conscientously/officially involved in a patient’s care (i.e. not curbside consults, not medical or insurance reviewer etc) has by default the right to review every MR that he/she feels may be in the patient’s interest to be reviewed. Of course patients should have legal options to specifically restrict or even abolish a provider’s access (although some physicians incl. myself would hesitate to accept such patients, depending on the scope and reasonning for the limitations).
While I appreciate that there is a celebrity spokesperson for the EMR with Jim Carrey (operating under the alias of “Will Saunders”), I want to point out that only #1 and 2 are good reasons (and 1 is probably a better reason than 2). The problem is interoperability and HIPAA laws, making data exchange, if at all possible, cumbersome at best (unless a patient gets all the care within the same data silo).
Re. #3 and 5, that’s a little like saying: This disadvantage of the EMR will improve or can be managed … but it’s not a genuine advantage (eg, yes, this new airplane prototype makes passngers throw up, but we are working on the problem, and in the future, there will be only some nausea and less vomiting … OK to say that, but not really a true advantage.)
Ad #4 – any data supporting that this won’t trigger an avalanche of false positive warnings? What I am rather hoping for is an expert system that is good enough that every practitioner goes over its differential diagnosis and thus misses fewer rare diagnoses, or diagnoses in a different than expected specialty/system.
The evidence so far does not support #2 either.
In Response to the question about #4
All clinical surveillance algorithms are tested with client specific data for sensitivity, specificity, and PPV (positive predictive value). This allows end users to see how the algorithm will perform based on the input data provided by the client site. The algorithms are continuously montiored, evaluated, and updated to maximize clinical accuracy and value.
We focus on emerging diagnosis, alerting our end users when an algorithm identifies a change or trend suggesting development of an emerging complication, adverse outcome, or diagnosis. This actionable information allows reduced lead time from identification of diagnosis to delivered therapy.
Christopher R. Kuzniak MD
Clinical Services Director
Office of the Medical Director
Midas+ Solutions, A Xerox Company
318 Seaboard Lane, Suite 110
Franklin, TN 37064