1. Electronic Health Records and Quality in a Physician’s Office By Wesley Eastridge, M.D. For SMA Annual Scientific Assembly November 11, 2005

2. Disclaimer: Owner/partner of Lakes Mercure electronic health record. Information in this presentation is generic to all electronic health records programs and not specific to any one.

3. outline  Discuss current quality initiatives  Demonstrate how electronic health records improved my practice of medicine  Caution on reckless use of healthcare information

4. Quality is…

5.  “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

6. Something we’d like to measure Something we’d like to improve

7.  Organizations already profile our practice

8.  Something we don’t want someone else measuring wrong to penalize us.

14. . “The duty of a physician is… Rarely to cure, often to make better and always to console.” - A French Physician

16. morbidity and mortality

20. No more lost charts

21. Organized problem list

22. Less medication errors

23. Remote access

24. Weekend Afterthought

25. Memos

26. Preventive Medicine

27. Guidelines Reminders

29. Quality Indicator Query

30.  Total patients: 612  459 within 90 days of last office visit = 75%  341 had a1c <=7, which is 63%

31. Drug Recall

32. Referrals

33. Medical Research

34. Quality

35. Into the Future…

36. Identification Technology

38. TN / VA Regional Health Problems

39. Care Data Exchange

40. Health Data Exchange GoofusGallant:

41. Health Data Exchange Goofus: Computer applications cost money and are frustrating to learn.

42. Health Data Exchange Goofus: Computer applications cost money and are frustrating to learn. Gallant: Doctors will order duplicate tests less because they have all the results available to them. The chance of adverse medicine interactions decreases as each prescriber knows the other prescriber’s medicines. Doctors can improve their practice as they get feedback from quality indicators.

43. Health Data Exchange Goofus: But those quality indicators can be misleading. One could be penalized with poor average blood sugar control indicators if they choose to take care of difficult and non-compliant patients who don’t want to do all the testing and careful schedules tight sugar control requires.

44. Health Data Exchange Goofus: But those quality indicators can be misleading. One could be penalized with poor average blood sugar control indicators if they choose to take care of difficult and non-compliant patients who don’t want to do all the testing and careful schedules tight sugar control requires. Gallant: Any quality tests we begin with will be imperfect, but the physician could be given opportunity to comment on their results, and there will be many indicators developed over time which are validated by larger studies.

45. Health Data Exchange Goofus: Who is going to want their medical information out on the Internet for all the world to see?

46. Health Data Exchange Goofus: Who is going to want their medical information out on the Internet for all the world to see? Gallant: Not for all the world. We have the technology to effectively restrict that information to only those who should know. We can let the patient see their own data, designate who gets to see it, and revoke permission at will. They can see a log of who has accessed their data as well.

47. Health Data Exchange Goofus: Big Brother is watching you! The government can use this information to dig up dirt on an opposition politician or an activist or agitator.

48. Health Data Exchange Goofus: Big Brother is watching you! The government can use this information to dig up dirt on an opposition politician or an activist or agitator. Gallant: It’s our responsibility as free citizens to protect our privacy. We have to put safeguards to keep administrators or officials from accessing the data without court orders.

49. And now, this…  Electronic health records are a powerful and useful tool for improving our ability to provide quality healthcare to our patients.

50. And now, this…  Electronic health records are a powerful and useful tool for improving our ability to provide quality healthcare to our patients.  Protection from misuse of information to the detriment of the patient or the healthcare provider will require vigilance and diligence.