Tuesday, March 9, 2010

Improving Care Coordination Through Health IT - Part I

Coordination of care is a significant problem in part due to the large number of specialists involved in patients’ care and a perverse payment system that rewards the most expensive care, doesn’t reimburse for proactive health management, and drives fragmentation of care delivery.

Into this web, steps Dr. Ann O’Malley and a research team from the Center for Studying Health System Change (HSC), asking how care coordination can be improved through health IT. Their findings are published in The Journal of General Internal Medicine, “Are Electronic Medical Records Helpful for Care Coordination? Experiences of Physician Practices”.  For their study, they interviewed physicians and staff with at least two years of experience with commercial ambulatory EMRs in place, along with CMO’s from Health IT vendors and national thought leaders on health IT.

'The study reports that a gap exists between policy makers' expectations that current commercial electronic medical records (EMRs) can improve coordination of patient care and clinicians' real-world experiences with EMRs.

Current commercial ambulatory care EMRs facilitate care coordination within a practice by making information available at the point of care but are less helpful for exchanging information across physician practices and care settings, according to the study supported by the Commonwealth Fund.

Clinicians identified many areas where both the design of EMRs might be altered, and office care processes modified, to improve EMRs' support for tasks involved in coordinating patient care.

Additionally, while current commercial EMR design is driven by clinical documentation needs, there is a heavy emphasis on documentation to support billing rather than patient and provider needs related to clinical management, the study found. And, current fee-for-service reimbursement encourages EMR use for documentation of billable events, office visits, procedures—and not for care coordination, which is not a billable activity.

"There's a real disconnect between policy makers' expectations that current commercial electronic medical records can improve care coordination and physicians' experiences with EMRs," said HSC Senior Researcher Ann S. O'Malley, M.D., M.P.H., coauthor of the study with HSC Senior Researcher Joy Grossman, Ph.D.; HSC Research Assistant Genna R. Cohen; former HSC Research Analyst Nicole M. Kemper, M.P.H., and HSC Senior Researcher Hoangmai H. Pham, M.D., M.P.H.

Excerpts from their findings that can be used to inform future EMR improvements include:

• EMRs may have unintended consequences for care coordination, such as creating information overload that complicates providers’ efforts to discern key clinical information. And, managing information overflow from EMRs is a challenge for clinicians.

• Clinicians believe current EMRs have limited ability to capture dynamic planning and the medical decision-making process in a way that supports future coordination needs—present EMRs focus on linear (moment-in-time) documentation while care coordination is dynamic and ongoing.

• Maximizing the potential of an EMR for coordination involves ongoing evolution of clinical care processes as well as clinician input on EMR design modifications and standards for data exchange to support those processes.

• Modifying reimbursement to encourage coordination of care by clinicians will likely drive clinicians to demand better EMR functioning to support coordination.

• Simply creating incentives to adopt EMRs as they currently exist, given the confines of the current payment system, may result in EMRs being designed for billing purposes primarily rather than for clinical relevance to patients and care coordination.'

The team identified EMR features that contribute to care coordination and areas for improvement.

In Part II of this article, HTN interviews principal investigator Ann O'Malley.


Anonymous said...

This series (Parts I & II) does not sufficiently address the attitude physicians hold towards care coordination. Because it is not billable on a fee-for-service basis, physicians don't feel they should do the work. If all Americans who have jobs held this same work ethic, they'd probably all be unemployed now. I've often performed duties outside my job description that I didn't get paid for specifically.

This is an excuse--not a justified reason or problem with the system.

internal medicine emr said...

Implementing EMR I think will definitely lead to better care..It could improve the quality and accuracy of medical-record documentation and improve quality of care.

family practice emr | pain management emr