Among opponents of EHR adoption, there is the notion that these health IT systems are a curse rather than a blessing and require clinicians to focus more on electronic documentation and less on interactions with patients. Certainly, a poorly implemented EHR system could have such negative effects. But what about one that is deeply integrated and widely used? Could it have positive implications for its users?
Those are just some of the questions to be explored by a team of researchers at Nemours which has received a $3.9 million grant from the Department of Defense (DoD). The HIMSS Analytics Stage 7 pediatric health system and Davies Organizational Award winner is charged with evaluating how physicians use best practice guidelines and identifying strategies for maintaining clinical skills and consistent levels of care. The end goal is to help the military reintegrate physicians after deployment and address any decay in their clinical abilities.
In short, the study is about tracking variations in care as a result of how frequently a physician sees a particular condition. “There always will need to be variations in care based on the physician’s knowledge of a particular patient, but we feel like we can identify the outliers and hopefully predict membership in that outlier group so that we can help reduce that,” says Tim Wysocki, PhD, Co-director of Nemours’ Center for Healthcare Delivery Science.
The EHR system allows the researchers to pinpoint specific activities that differ from established methods for treating a specific condition such as a chronic disease. What it is not is a mechanism for rating physicians based on their use of that EHR system, something Wysocki made abundantly clear.
“Someone’s use of the EMR is not necessarily an indicator of the quality of their performance, but in a large enough sample of physicians and a large enough sample of patients we think there is enough granularity in our system to detect unwanted variations,” he adds.
That’s the message that the leadership of this and similar project needs to get across to physicians so as to mitigate any concerns the latter might have.
“For it to become a really functional tool in that respect it needs to be done by engaging the physicians themselves in planning what they want to track, what goals they want to set, and customizing the data collection so that their goals are met,” Wysocki reveals.
Because of its high level of EHR adoption and the maturity of its Epic EHR, the pediatric health system is in the perfect position to conduct the research.
“There are quality improvements or learning health system kinds of issues that the EMR permits that in principle are possible with a paper record, but in practice that’s just not feasible,” Wysocki explains. “But when you’re capturing data electronically, it is much easier to make use of that data for real-time decision-making.”
Given the changes currently taking place in healthcare, namely the shift from pay for service to pay for performance, the ability to identify ways of improving the quality of care delivered by physicians gives healthcare organizations and providers valuable insight.
“From the standpoint of the practicing group — whether it’s a clinical division or what have you — it behooves them to make sure that the care they deliver is delivered as efficiently as it can be, so reducing waste and also making sure that the right tests, the right medical decisions are made in a timely manner,” says Wysocki.
With accountable only growing, the EHR system becomes not only a tool to capture a patient’s data but also a means for ensuring that physicians are delivering the right kind of care at the right time.
