By J. Scott Litton, Jr., MD | January 20, 2012
A report recently released by CMS shows that 2.5 billion dollars was paid to medical offices in the last quarter of 2011 for the use of EHRs in a meaningful way. Just what does this embracing of technology mean to the patient care we provide?
I will give an example of how my EHR allows me to effectively care for my patients while dealing with a busy waiting room and managing time to effectively care for patients.
My first patient of the day is a 66-year-old male in for routine follow up of hypertension and diabetes. A quick analysis of the clinical rules indicates he is due for a hemoglobin a1c measurement, a PSA measurement, fasting lipid profile, and a routine colonoscopy. Using an old fashioned paper chart can provide the same analysis of tests needed, but exactly how long would it take to flip through page after page in order to arrive at the list of needed test items? The patient’s blood pressure is also not optimally controlled and he has a new complaint of unilateral knee pain.
Using my EHR, I am able to click on each test that is needed and generate an order for each one, along with matching the order to the correct ICD-9 code. In about 15 seconds, I have ordered the needed tests and ready to focus my attention on his suboptimal blood pressure control. After reviewing the needed lifestyle changes and changing his medication dosage, I am then ready to focus on his new complaint of knee pain. Documentation of the examination findings and history information is efficiently completed and an order for a unilateral x-ray series of the knee is completed. This leaves a few minutes in the encounter for me to ask him about his family and job status and also to gain some more insight as to what other factors might be contributing to his current medical findings.
I am able to review his x-ray findings the day after it has been completed and also review the results of his laboratory test results. My EHR also offers a secure online patient portal. Using the capabilities of the online portal, I am able to send the patient an electronic copy of his laboratory results and attach my interpretation of the findings and recommendations for lifestyle/medication changes. Also included is the result of his x-ray report, along with my interpretation and recommendations. Once the patient receives the message and has displayed it on his computer, I am able to get a read receipt and be assured that my patient has received the results. The communication between myself and my patient is documented in the patient’s chart and such communication has been completed without the need of occupying my staff’s time for receiving the interpretation from me and contacting the patient by phone and delivering the results second hand.
One of my other patients recently presented to the emergency department with a complaint of increased nausea and heartburn. After reviewing the results of the emergency department record, I was able to contact my patient securely by the online portal and ask him if he was still having problems with the original complaint. He indicated that he was, and I offered him a next-day office visit to follow up. It turns out that the patient had been due for an upper endoscopy, which I had reminded him of at a prior office visit, and at my recommendation he did consent to having the procedure completed. We scheduled him for an elective endoscopy the following week and after I completed his procedure, it was determined that a medication change was indicated. The medication was changed, some lifestyle changes were recommended, and the patient did indicate to me at a later follow-up visit that his problem was now resolved.
The two examples listed above are just a small portion of the efficiency that my medical practice is able to observe by using our EHR in a robust manner. Routine patient satisfaction surveys by our patients indicate that they are very pleased with their level of care and that my use of tablet computers in the exam room does not produce a barrier to the doctor-patient interaction.
Further, the use of the online patient portal allows my patients to feel that they have no barriers in sending their physician a message regarding their current status. Rather than letting my nurse review such messages, I choose to read them myself and respond appropriately. Many of our patient messages are addressed by advising a follow-up appointment be scheduled, however it allows for very efficient care to be delivered.
As the current status of health information technology rapidly advances and evolves to address patient care, it is very important for physicians to embrace the new technology as a tool for providing more efficient and timely care for their patients. After using my current EHR for over eight years now and seeing the new applications released and tools available for caring for my patients, I am very eager to demonstrate my EHR system to fellow physicians in my area so that they too can enjoy the benefits of providing cutting edge care for their patients.