Today “the average full-time primary care practitioner might take care of 2,000 people,” notes Christopher Campanile, M.D., who practices in a medical home at Coastal Hillside Family Medicine in Pawtucket, R.I. He believes you cannot do this work right without electronic medical records. They prompt the doctor to deploy needed tests, enable doctors to see a patient’s history at a glance, and help avoid unwelcome drug interactions.
For years U.S. doctors lagged behind the rest of the developed world in computerizing their medical records, but that changed dramatically in 2009 when the federal stimulus bill brought forth more than $19 billion in funds to help practices go digital. The percentage of doctor’s offices with electronic medical records shot up from 42 percent in 2008 to 72 percent in 2012. There have been complaints that doctors are asking questions needed more “for the record” than relevant to the particular patient visit and paying more attention to entering data into the computer rather than looking patients in the eye. It’s hoped that professionals will become more facile as they adjust to the systems. Meanwhile, patient-centered care is benefiting in many ways:
Prevention and checkup reminders. “We don’t wait for you to remember it’s time for a screening mammogram,” says Christine Sinsky, M.D., who practices in a medical home at Medical Associates in Dubuque, Iowa. “We’ll reach out to you.”
Many physician practices have for decades tried to prompt patients to get needed tests and checkups, but the effort is vastly simplified by the use of electronic medical records. In the suburban Philadelphia medical home, Warning recalls that before the advent of electronic records, “If we told a diabetic patient to come back in a month so we could check their blood pressure, we didn’t have a robust tracking mechanism for knowing if they didn’t come in.” But today the records can automatically flag patients who need to be checked.
'We don’t leave anything to chance. We make the appointments for patients to see the cardiologist, rheumatologist, or pulmonologist.'—Christine Sinsky, M.D.
Easier communication with patients. Of course patients still have to be willing to participate in their own care. Witness Robert Eley, 58, who has diabetes and says he “would basically ignore” all those checkup reminders the Bon Secours medical home had been sending until he had a heart attack last March. A couple of angioplasties and a hospital stay later, he was ready to play ball. Now he checks his blood sugar three times a day and e-mails the results every evening to his primary care physician, Andrew Rose, M.D., through the practice’s electronic patient portal. “He tells me whether to adjust the units of insulin I’m taking, whether they look good, what’s the reason for a spike,” Eley says. “I’ve lost 20 pounds and I’m trying to get more exercise in.”
Under the old system, Rose says, that wouldn’t have been possible. “You’d tell patients to call in their numbers every week. The nurse would write it down, and it would sit on my desk for a week,” he says. “Now, it’s in my e-mail inbox. It’s made life so much easier.”
Now that Eley will actually keep his appointments for those checkups, he’ll be able to look up his lab results at the online patient portal as well, Rose says.
Managing care transitions. At a minimum, all providers within a health system are generally able to access patient records. In some cases, practices may be able to communicate with local hospitals, either directly or through the intermediary of an insurance company.
“In our practice, everything’s electronically connected, so we know when a patient goes into the hospital,” Rose says. “When a patient gets discharged, our nurse navigators get in touch within 24 hours. We eliminate any confusion about medicine changes or discharge instructions, and prevent readmission.”
The system still has an important gap. The goal of true “interoperability,” in which all providers anywhere can see a patient’s record, remains more a dream than a reality. For example, a doctor isn’t likely to receive electronic notice for patients seen in an out-of-town emergency room.
Giving doctors feedback. Pro Health Physicians, a primary care practice with about 340 providers scattered around Connecticut, uses its electronic records to prepare monthly report cards letting each practice know where it stands on various quality measures.
Timothy J. Buckley, D.O., in Pro Health’s Higganum location, says the first report showed that his office was prescribing too many costly name-brand drugs and not enough affordable, and equally good, generics. Today his office’s generic prescribing rate is better than the average Pro Health practice’s.
“Doctors are smart and have egos,” Buckley says. “And when you hand me a report that says I’m below average, you can bet I’m going to work harder.”
Coordinating care. Garry Pape, a 66-year-old retired factory worker from Rickardsville, Iowa, ruefully describes himself as “one of the 5 percent of people who use 95 percent of the insurance money.” A Vietnam veteran, Pape has a host of medical conditions, including, most recently, recurrent lung cancer.
His primary doctor, Christine Sinsky, has sent him to specialists aplenty to take care of his catalog of ills but never loses the thread of his treatment.
“We don’t leave anything to chance,” she says. “We make the appointments for patients to see the cardiologist, rheumatologist, or pulmonologist. They leave with the appointment card in hand, not just a recommendation.”
Since most of the specialists are part of Sinsky’s large medical practice, she says, “if I make a change in Garry’s medications, the oncologist will see it at the next visit and be working off an accurate list.”
Pape keenly appreciates what Sinsky and her colleagues do in part because for four years, when his employer dropped Sinsky’s practice from its health plan, he had to switch to another doctor. “I didn’t get any of the follow-ups,” he says. As soon as he retired and went on Medicare, he went back to Sinsky.