Health Advantage for Patients Who Use EMR

Electronic reminders can help heart patients stay healthy and on their medications even though they are no longer being closely monitored, new research shows. The study is among the first in the U.S. to show that electronically maintained health records can improve outcomes among heart patients and possibly even lower health care costs.

Researchers followed 421 patients with coronary artery disease enrolled in the Kaiser Permanente Colorado managed care health plan. Medical records for the patients, including physician visits and laboratory and pharmacy data, were kept electronically. The patients were participants in an intensive pilot intervention program designed to keep them on cholesterol-lowering and blood-pressure-lowering drugs with the goal of reducing their risk for future heart attacks and strokes.

The program -- which linked patients to teams of cardiologists, pharmacists, nurses, and primary care doctors through electronic health records and direct counseling -- resulted in high rates of patient drug compliance and attainment of goals for blood pressure and cholesterol levels. After participation in this intensive program, half of the patients were moved to a program where they were followed only by their primary care doctor and received far less costly electronically generated reminders of needed lab tests. These electronic prompts proved to be just as effective as the intervention program for keeping cholesterol and blood pressure at goal levels. Using technology and integrated systems already in place, we can help keep patients healthy for longer and deliver continuity of care in a cost-efficient manner.

EMR vs EHR vs PHR vs LHR

Electronic Medical Record (EMR) encompasses the medical history – tests, diagnoses, treatments and other elements – of a single patient specific to a particular facility. The record is owned by the provider. EMRs may be used to achieve a more efficient exchange of information within the facility and to guide clinical decision-making. Likewise, an EMR system describes the local provider’s computerized environment that makes these records possible.

Electronic Health Record (EHR) ideally includes a patient’s complete medical history, spanning multiple providers and geographies. A comprehensive EHR requires compilation of data from various EMRs. In the case of personal health records (PHR) such as those provided by Microsoft HealthVault® or MyHealthRecord®, and Google Health®, the patient owns the record, but most EHRs are owned by a facility, insurance company or insurance consortium. The EHR is the type of record proposed to reside on a shared National Health Information Network.

Legal Health Record (LHR) is similar to an EMR in that it comprises a patient’s information from a single care provider, but carries with it a more binding and unalterable structure. According to the American Health Information Management Association (AHIMA), the LHR serves as the hospital’s permanent business record and would be released upon request if the appropriate patient consent was on file.

HL7 finalizing PHR standards

Health data standards group Health Level Seven (HL7) has begun accepting votes on whether or not to approve its Personal Health Record Functional Model (PHR-S), an interesting development given that health plans, employers and providers still don't seem to have agreed upon what content a PHR should actually contain. Both members and non-members of HL7 can vote on the standards, though non-members must pay an administrative fee to participate. If approved, the HL7 standards will become a draft standard, and will be refined for two years until they comply with ANSI requirements.

HL7's standards define what functions a PHR and security features are common in existing PHR platforms, and offers ideas on how to share between PHRs or from PHR to EMRs. PHR-S may be the first industry standard defining core functions for PHRs, according to the group's statement.

Health IT is now a consumer buzzword

The pre-HIMSS show excitement has started building. I think this should be one of the most vibrant--and overwhelming--shows in the history of HIMSS itself. Why? Well, in part, it's because this has to be one of the first times in any of our professional lives when health IT went from the concern of group practice administrators and hospital leaders a topic that seems to interest everyone but my grandma. On the other hand, I'm not sure I like where this is going. Let me explain...

One of the most obvious indicators that health IT has gone public that there are bills and proposals directly affecting the industry mounting up daily. These days e-prescribing, PHRs, EMRs and health information exchanges are on the lips of elected officials who could barely use their own Blackberry otherwise. While President Bush has encouraged much of this, if the Democrats seize the White House, I don't think that's going to change. Health IT has moved from esoteric to a matter of mainstream discussion, and that's that.

This is something of a problem. After all, while legislators may be well-intentioned, they're usually not subject-matter experts, so they may not have a realistic picture of what problems you face. Besides, while they have to win some ill-defined popularity contest--if EMR is the flavor of the week in the mainstream press, well, then, everyone should have one--you just want to make sure your organization keeps delivering good care. We're talking a slight conflict of interests here.

I don't know about you, but when I'm at HIMSS, I'm usually more interested in talking with vendors who are solving non-trendy problems in a sensible way than listening to rah-rah new stuff. That's particularly true now that consumer interest has seeped into the industry and begun influencing how products are developed, sold and presented to you.

But hey, I don't want to be too cynical. Maybe there's some things that are both praised by the vox populi and worthy of being implemented. All I know is, when I'm at HIMSS, I'm planning to keep my trendiness quotient to a minimum

What's a PHR?

One view comes from America's Health Insurance Plans: "The industry model personal health record (PHR) is a private, secure web-based tool maintained by an insurer that contains claims and administrative information." Makes sense if you're a health plan, definitely.

Or what about AHIMA's take: "A PHR is an electronic, universally available, lifelong resource of health information maintained and owned by the individual." Should calm the nerves of the privacy advocates, no?

The HIMSS definition takes us in a slightly different direction: "To enable the goals of reducing medical errors, improving quality of care, and improving the validity of information available to care providers, Personal Health Records (PHRs) function to consolidate an individual's medical information in one place." This one doesn't dwell on a patient's rights so much as the comprehensiveness of the data, which is of course a wrinkle worth considering.

Yes, I think it's pretty clear what the intent of various employer- and healthplan-driven PHRs is (cheaper, better care), but that's not enough. You can know that you want to ride from Phoenix to Denver without knowing what parts are needed to build a car.

I'm taking up this issue again, in part, because that the indefatigable folks at HL7 are voting on a functional PHR model over the next few weeks. While I'm delighted to see some consensus building on key PHR functions (such as wellness reminders or prompts to look at lab results), that still begs the question of what the ultimate goal of a PHR is. Quick: tell me in one sentence what your PHR effort is trying to accomplish. Not so easy, is it?

When it comes to PHR content, some key unanswered questions include:

* What is the core clinical data set a PHR must contain to deserve the name? Patient medical history, drug allergies, care plans, genetic data, what?
* Does the name "personal health record" imply that it's largely or entirely maintained by consumers, or are consumers merely its custodians?
* What's the benefit of maintaining a PHR? (No, I don't agree that the answer to this is obvious.)
* What is the minimum amount of data a PHR must contain to be useful?

Yes, I realize that health plans, employers, software vendors, standards groups and even consumers will have to do a lot more talking before they arrive at a shared conclusion on these issues--and that technology never moves ahead without some fuzzy logic in between--but in my view things are still too fuzzy. As I see it, it's critical to get bit more clarity on core issues like, say, whether a PHR should be populated by claims data, consumer self-reporting, EMR data or a mix before more dollars are spent. In the mean time, let's not put the cart before the horse, shall we?

Parkland Moves to Paperless Patient Records

A wireless, electronic medical record system that went live at Parkland Health & Hospital System makes the hospital one of the first integrated health systems in North Texas to move to the technology. Charting and documentation that was once done on paper has now been transferred to a computer-based system, and nurses and other health providers use mobile computer workstations at bedsides to document medical histories, physician orders, vital signs, etc. Jack Kowitt, Parkland's chief information officer said that Parkland now has the most extensive access to electronic inpatient medical records in the medical district and patient information is available at the stroke of a key from anywhere in the hospital. This allows staff to be more efficient, allowing them to focus on patients and patient care. It also helps to ensure accuracy. Testing that went on for the last six months by IT specialists and medical personnel is now complete and included training almost 6,500 nurses and other providers. In order to complete the process, because of the age of the hospital, new hardware and infrastructure has to be installed. This included more than 1,200 workstations, 300 printers and more than 800 wireless antennae. Through research carried out by a Parkland physician a connection between investments in IT and quality of patient care was seen, and the lead researcher, Dr. Ruben Amarashingam, associate chief of medicine services at Parkland found that Texas hospitals with electronic records, automated systems and other technologies had fewer complications, lower costs and lower mortality rates. The study was published in the Archives of Internal Medicine. With the launch of the inpatient and pharmacy systems a $45 million, three-year program to place electronic medical records throughout the entire Parkland system, including the main hospital campus and 31 off-site clinics will be ongoing throughout the year, and by the end of the summer, EMRs will be active at at Parkland's 11 school-based clinics. Fully 120 specialty clinics will go live throughout the next year. Last year, Parkland's Emergency Room implemented a similar system specifically for emergency care.