How I Became a Better Doctor
OPINION – September 12, 2011 -- In mid- June, I was invited by President Obama to a White House summit to share the lessons we Oregon providers have learned about health information technology. More appropriately, I wanted to share how electronic health records have helped me become a better doctor.
Oregon is well known nationally as an early adopter state, specifically in the new digital world of health care. I went to this summit carrying the knowledge of my professional experience as well as key recommendations from a number of local organizations with whom we’ve worked, such as the Oregon Medical Association, Portland InterHospital Physicians Association and Oregon’s Health Information Technology Extension Center.
When I first began practicing medicine, I quickly came to realize that I, alone, could not possibly track what my patients need at each and every encounter, including all immunizations, health maintenance needs, medication compliance, and chronic disease management, so my colleague and I began the process of moving to an electronic health record system. That was six years ago.
Since that time, I, and so many of my provider colleagues far and near, have experienced the challenges and opportunities this newer technology presents. The cost of the purchase and implementation of even the most basic of electronic health records systems; the decreased productivity of clinic staff before, during and after installation; and the cost of upgrades, peripherals and updating interfaces and other systems are barely, and rarely, offset by federal payments and incentives. Billings don’t change much in the short term, and thus, there is limited recoup for these tens of thousands of dollars being spent per provider.
In short, health transformation is coming at a high price.
To further complicate the already complex health care environment, there are many systems vendors. Each vendor has a different product that works in a slightly different way. Each system has to be extensively customized to fit your practice. This takes a ton of time initially but requires ongoing efforts as new guidelines are released and old ones are changed. Due to the amount of time and money invested by each practice in any one particular electronic health record, we are understandably reluctant to change systems. We struggle with a system that is not keeping up with new guidelines or not meeting new Meaningful Use rules and we have no recourse but to sit and wait or actually change systems (which is not worth the time or the money to do).
At the summit, there was extensive conversation about Health Information Exchanges. But, again, without across-the-board standardization, the complexity of all different computer systems, make exchanges unmanageable. For our small, rural clinic in Canby, we have encountered all of these challenges and more. However, by tackling one small piece of the puzzle at a time, we are moving forward. As much as we all are wary and frustrated with data, we have found accurate data is extremely helpful to drive changes within our practice. We have also found the time and energy needed to extensively customize our EHR (electronic health record) allows us to enter data in the order and manner that we see our patients, thus improving our speed. We have eliminated transcription. Our charts are done by the time the patient leaves the exam room with a detailed summary of their appointment. Our charting, therefore, is substantially more complete and accurate. By developing a thorough alert system covering immunization, chronic disease management and routine health maintenance, we address all of the health needs for each patient at each encounter (including nurse visits) instead of just the needs they identify.
Our recent projects have afforded us the opportunity to keep medication reconciliation accurate after specialty appointments or hospital care; update screenings for breast, cervical and colon cancer; vastly improve both adult and pediatric immunization rates; achieve health information exchange via a secure network with a few specialty clinics; ensure patients get up-to-date diabetes, hypertension, and hypercholesterolemia care; implement a recall system to address orders patients have not had done; track and manage our referral system; ensure standardized medication refill policies; and empower each staff member to work at the top of his or her license.
Our practice has become endlessly more efficient by reducing waste and duplication, and via this administrative simplification. Although we, as a clinic, are seeing improved efficiencies and some financial return on our investment, the big payoff and real reason that has been the impetus for all of our change is improved patient care. We know it and our patients know it.
Dr. DeOna Bridgeman is affiliated with the Davies Clinic P.C. in Canby, Oregon and is a member of the Portland IPA.