healthmedicinet

A strategy to increase their utilization, lessen the strain of physicians, and improve patient care has been established by an early proponent of the electronic health records currently present in hospitals across the nation.n

The reform plan was created by Don Detmer, MD, MA, of the University of Virginia School of Medicine and Andrew Gettinger, MD, of the Geisel School of Medicine at Dartmouth. As vice president for electronic records at UVA in the early 1990s, Detmer led the university’s deployment of electronic physician order entry.n

Detmer and Gettinger explain what they call “essential electronic health reforms for this decade” in their new proposal, which was published in the Journal of the American Medical Association (JAMA).”nn

Electronic health records, commonly called EHRs or EMRs, were introduced to improve record-keeping and assist doctors and other health professionals in providing the best care possible. But with their implementation came increased documentation responsibilities that added to an already heavily workload for clinicians and that can contribute to provider burnout. Further, many argue that the required documentation can distract from focusing on patients during visits.n

Detmer and Gettinger seek to tackle these problems head-on. “Lack of action by national leaders saps the energy and motivation of health workers,” Detmer said. “Health and safety should count for more, and action on our recommendations could improve both.”n

Enhancing electronic health records

The authors call for three key changes they say could be implemented fairly easily:n

• Removing all administrative and regulatory documentation obligations for care providers during their “clinical time” with patients, except for matters pertaining directly to the reason for the patient’s visit. This would effectively separate care provision from payment and billing, cutting through red tape. For example, Detmer and Gettinger suggest streamlining all insurance approval and authorization practices to eliminate, as much as possible, the need to get “pre-approval” from insurers for treatments.
• Adding the ability for patients to enter information in their electronic health record, making them more active participants in their care.
• Reinventing the “clinical note,” one of the most common records providers create, to better support patient care. These notes, Detmer and Gettinger say, should directly address expected or desired results from each visit and could include timelines, when possible.

“What will be the effect of these interventions?” the authors ask in their article. “A major move in these directions will allow far greater creativity and innovation between clinicians and patients to transcend the traditional boundaries of what constitutes care. The focus of care can broaden to consider all the social determinants of health [the external factors that affect outcomes] that may be relevant to a particular patient.”n

In addition to those proposals, Detmer and Gettinger argue that the most urgently needed change is the least likely to be implemented. They say there is a desperate need for “unique personal safety identifiers” that would let hospitals, employers, health plans, insurance companies and other healthcare organizations streamline operations by jointly identifying individual patients.n

That idea was originally mandated in 1996’s Health Insurance Portability and Accountability Act (HIPAA) but has not been implemented at the national level because of concerns about patient privacy and other issues. The lack of such consistent identifiers, Detmer and Gettinger maintain, “presents a continuing threat to privacy, safety, cost reduction and administrative errors.”

Next steps

While the doctors acknowledge that national identifiers are likely off the table, they say that enacting the other changes they suggest could make a big difference for both care providers and patients.n

“Although addressing shortcomings in EHRs will not cure all that ails our current health care system, implementing these recommendations should positively affect patients and clinicians and move us toward the original vision of a patient-centered, technology-enhanced health care ecosystem that is designed to significantly improve outcomes at a lower cost, with more satisfied patients and clinicians,” the authors conclude.