The Commonwealth Fund published a study earlier this year based on a survey of more than 1,000 federally qualified health centers (FQHCs) around the U.S. While this study covers a considerable number of topics, there is a section very pertinent to health information technology worthy of comment. The researchers noted that 40% of the approximately 795 responding health center indicated the use of an electronic health record. The researchers then assessed the health IT capacity of centers based on thirteen (13) functions and then stratified their indications of ability to perform on key patient care issues (low = 0-3; medium = 4-8; high = 9-13).
The 13 capacities included: EHR throughout health center, electronic access to lab test results,electronic ordering of lab tests, electronic entry of clinical notes, electronic alerts or prompts about potential drug problems, electronic list of all medications taken by a patient, electronic prescribing of medication, list of patients by diagnosis, list of patients by lab result, list of patients due or overdue for tests or preventive care, lab tests are electronically tracked until results received by clinicians, patients are sent computerized reminder notices for preventive or follow-up care, and provider receives a computerized alert or prompt to provide test results.
Not surprisingly, the more health IT capacities, the better a health center performed. Here are some examples: Of the centers with high health IT capacity, 68% of the centers were able to track laboratory tests until results reach clinicians; 51% were able to prompt providers to give patient test results; and 43% generate alerts at the point of care for appropriate services. In contrast, centers with low health IT capacity had the following respective results: 45%, 25%, and 10%. When it came to generating lists of patients, 83% of high health IT capacity centers could do so based on patient diagnosis. Low capacity centers were at a respectable 56%. However, there were dramatic differences in the ability of centers to create lists of patients by lab results (66% versus 23%), by health risk (48% versus 12%) and by those patients overdue for tests/preventive care (47% versus 9%).
These data highlight that while introducing basic health IT functions may be an easy way to get started, achievement of health IT-enabled patient-centered care and population management require systematic application of several health IT capacities. But most practices do not/cannot/should not introduce all the features embedded in their EHR at once. However, achieving meaningful use and higher practice
functions will create pressure for practices to move swiftly.
So – here’s the question:
Which five of the capabilities below (modified from the Commonwealth Fund study) would you want to implement in the first phase of EHR implementation to achieve an early positive impact on patient care and practice operations? If your practice is using an EHR and has advanced past the beginning stages of use, what was your implementation sequence? Feel free to add your own ideas for important capacities not listed below.
- Electronic access to all test results (labs/radiology, etc)
- Electronic ordering of all tests (labs/radiology, etc)
- Electronic entry of clinical notes
- Electronic alerts or prompts about
potential drug interactions/allergies/reactions
- Electronic list of all medications taken by a
- Electronic prescribing of medication
- Electronic problem list
- Electronic health maintenance tracking
- Ability to generate lists of patients by diagnosis
- Ability to generate lists of patients due or
overdue for tests or preventive care
- Ability to track lab tests and other studies electronically until results received by clinicians
- Ability to generate computerized
reminder notices for preventive or follow-up care
- Computerized alerts or prompts to clinicians when patient test results are available
- Ability to generate patient care summary to hand to patient
- Ability to produce patient-oriented education materials through the EHR
This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.