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March 2014:

EHRs: Passing the Crossroads, Driving Toward Mass Acceptance

By Mark R. Smith, Editor-in-Chief

March 4, 2014

Posted in: News

A year or two ago, the buzz about Electronic Health Records (EHRs) concerned getting as many hospitals, practices and doctors as possible to leave their paper trails in the recycle bin and to start investing in their digital futures.

That’s still part of the buzz. However, as more and more users have implemented EHRs into their workflow, much of the talk today concerns patient privacy issues. Patients’ questions stem from concerns about how easily their medical information can be compromised — especially in the wake of the recent massive breaches experienced by Target and other retailers — as well as how it can simply be passed on from one doctor to another.

Making that easy is part of the idea, of course. But the exchange of information has to happen with more than just a patient’s consent; if it doesn’t, someone’s podiatrist might end up knowing that the person being treated is infected with HIV or that they’re bipolar.

Still, the Columbia-based Chesapeake Regional Information System for our Patients, better known as CRISP, reports that 90% of the primary care physicians in the U.S. through Regional Extension Center (REC) program, have achieved what the industry terms meaningful use of EHRs, with the startup program set to conclude in April.

So, whether a practice or a doctor has hopped aboard the EHR express or not, the train is clearly leaving the station. “Some practices did not opt to spend the resources to change over to EHRs,” said Daniel Wilt, vice president of operations for CRISP, “but everyone is in agreement that they are prominent in the future of health care.”

Privacy Concerns

Concerning patient security, Kathryn Whitmore, founder and managing principal with STS Consulting Group, of Sparks, explained that the three most common features that are available to patients via a patient portal view into the EHR software are secure messaging, which basically concerns sending e-mails; scheduling appointments; and receiving/viewing test results.

The latter is key, “because patients traditionally have had a physician share and explain results to them,” said Whitmore, “but technology now allows us to provide patients the ability to view online the same information that the doctors can, which means that communicating with your doctor is even more important. For a negative test result, many physicians will still share results with the patients before they release the result to be viewed online by the patient.”

Still, those much-discussed breaches, Whitmore acknowledged, are impossible to prevent. “So, it’s crucial,” she said, “to make sure that they are caught early and addressed.

“Remember, there are also very specific guidelines under the Health Insurance Portability and Accountability Act (or HIPAA) concerning Protected Health Information,” she said. “While some data, such as a person’s banking information, is private, know that when a pharmacist enters information about the prescription filled into the EHR that someone in an emergency room will see it — and that small bit of information might save a life as doctors know what medications a patient is taking and won’t order something harmful.”

However, some people will ask if the patient’s orthopedist really needs to know the results of an HIV test, for example. That answer is no, and “that’s why patients really want to have some control over their health information and provide consent to which doctors are able to access certain portions of their health records,” Whitmore said.

More Info, Please

That means learning how that can be done is getting more important. Just ask Debra Roper, director of ambulatory information systems at Anne Arundel Medical Center (AAMC), in Annapolis.

“We engage our patients and inform them about EHRs, what they do,” said Roper. “I had one patient ask if providing information at AAMC was the same as going to her regular M.D., and I couldn’t tell her that it would be, since not every doctor in our community is on our system.”

Aside from the aforementioned general fear, other obstacles her department encounters include connecting with vendor portals that may not “talk” to each other and trying to assist patients in rural or economically depressed areas who don’t have access to the technology.

AAMC management tries to overcome those issues by educating its patients and incorporating patient advisers in its work groups.

“We know that something has to be done to edify the patients and get them up to speed on how this works,” Roper said, “and some observers feel that more assistance from CRISP would be beneficiary. Overall, the profession needs to do better.”

Roger, That

Steven Daviss concurred with Roper’s observations. “Patients in Maryland still have no idea what information is out there about them, because there has been no marketing effort to inform them of what’s gone on,” said Daviss, chief medical information officer at M3 Information, a mental health information technology company in Rockville.

Allowing that there is a lot of trust involved, Daviss still approaches this part of the equation with caution. “It only takes one bad actor to do something,” he said. “Let’s say you have a public figure who’s being treated for a health problem, like HIV or bipolar disorder, and that gets out. We don’t have a solid way to [prevent] that yet.”

Another tangent that Daviss feels needs to be addressed is getting more primary care doctors aboard the train. “All [of the] acute care hospitals in Maryland are on board, but CRISP wants more practitioners on board,” he said.

“Let’s say I’m a primary care doctor and it would be useful to know if my diabetic patients have gone to the primary care ward in the hospital,” Daviss said. “It may help to know what their hemoglobin scores are.”

That type of situation is one reason CRISP is pushing its notification service. “It will allow other doctors to know, within five minutes, if one of their patients is in a hospital’s emergency room, so they can provide information to help the emergency room doctor,” he said. “That’s a huge step forward.”

Positive Outcomes

Taking huge steps forward are just what the industry needs, said Michael McNees, CEO of Syndicus Inc., of Annapolis. “We’ve come a long way and worked hard, and any doctors who have not adopted EHRs are the dinosaurs,” said McNees. He noted that Maryland “is in the top 10 in the country in terms of getting doctors,” mainly those from small practices and the hospitals, on board with the movement.

Now, McNees said, it’s a matter of what’s going to be done with them.

“Will they be patient-centered or will they be doctor-centered?” he queried. “Today, the question really concerns access and providing a secure environment that is easy to use. I think providers will cooperate with the patients in terms of what access the patients want.”

On that note, McNees pointed to the influence of the Patient-Centered Outcome Research Institute, an Affordable Care Act-authorized nonprofit. “They put the money out — billions — to encourage EHR adoption. And now the doctors have the EHRs, so how are we going to produce positive outcomes?

“By getting the providers’ payment based on the outcomes,” he said, “which will increase efficiency and stop a great deal of wasteful health care spending.”

And, after all, isn’t that the point?

“We’re finally getting close to having all of the health records for a given patient together,” said Whitmore. “This isn’t a revolution, but an evolution. And the more information a doctor has, the better care a patient can receive. That information can save lives.”

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