EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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How Patient Access to Doctor Notes Affects Physicians

How Patient Access to Doctor Notes Affects Physicians | EHR and Health IT Consulting |

Releasing physician notes to patients is scary for many doctors. Common concerns include patient misunderstandings regarding the health information included in the note, damaged physician-patient relationships due to the content included, and a flood of questions from patients who are confused about clinical terminology.

But presenters at the Healthcare Information and Management Systems Society (HIMSS) conference in Chicago said it's time to put those concerns to rest.

The presenters, Jan Walker, assistant professor at Beth Israel Deaconess Medical Center and codirector of the OpenNotes initiative; Amy Gleason, chief operating officer at CareSync; and internist Susan Woods, director of patient experience and connected health at the Veterans Health Administration, agreed that providing patients secure online access to physician notes is a win-win for all parties.

Here are three key findings they shared during their presentation:

1. More patients want — and expect — access to physician notes.
During the presentation, Walker shared results from a one-year Open Notes demonstration project funded by the Robert Wood Johnson Foundation. About 100 physicians from Beth Israel Deaconess Medical Center, Geisinger Health System, and Harborview Medical Center participated in the project, affecting more than 13,000 patients in multiple locations.

Jan Walker In the demonstration project, patients received an alert that their note was ready to view as soon as the physician signed the note (and they received another alert prior to patient visits).

Walker acknowledged that one big question prior to starting the project was whether patients would be interested. Ultimately, over the course of the 12-months, 82 percent of patients at Geisinger who had a visit to their provider opened at least one note.

Notably, that included older patients, sicker patients, and less educated patients. In fact, patients with no more than a high school education looked at notes at same rate as everyone else, said Walker.

Ninety nine percent of patients said they wanted to continue having access to physician notes, and 85 percent said availability of physician notes would influence their future choice of providers.

2. Patients report positive results when they can view physician notes.
So what effect did that increased access to physician notes have on patients? The study suggests a positive one. About three-quarters of the survey respondents said they take better care of themselves, understand their health better, feel more in control, take their meds as prescribed at greater rates, and feel better prepared for patient visits, said Walker.

Other positive results Walker said patients reported included:

• Improved recall of the patient visit and improved ability to adhere to follow-up recommendations, because looking at the note helped patients refresh their memory.

• Improved trust between patients and their physicians because it removed the "mystery" of what the physician was writing in the record.

• Improved ability of patients to be prepared for their next visit and to engage in shared decision making.

3. Physicians report positive results when patients can view their notes.
While many of the physicians reported concerns regarding how patient access to notes would affect their work flow, very few actually saw these concerns come to fruition, according to Walker.

Only 2 percent reported longer visits, 3 percent reported spending more time on patient questions, and 11 percent reported spending more time on documentation. In fact, Walker commented that a common question received from physicians who were participating in the demonstration was whether the access to physician notes feature was on, because they weren't getting questions from patients about the notes. 

And, contrary to the fear that patients might be confused, unnecessarily worried, or offended by the notes, only one percent to eight percent of physicians reported these problems, said Walker.

Perhaps most telling is that, at the end of the 12-month demonstration, none of the participating primary-care physicians stopped participation, even though that was an option. "We really believe this is the right thing to do," said Walker.

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EHRs Improve Mortality Rate and Increase Patient Satisfaction

EHRs Improve Mortality Rate and Increase Patient Satisfaction | EHR and Health IT Consulting |

Electronic health records (EHRs) have been adopted by thousands of hospitals. reported that nine out of 10 of all eligible hospitals achieved meaningful use through December 2014.

Once hospital staff members and physicians became accustomed to EHR technology, they and their patients reaped the many benefits offered by switching from paper to digital health records, including:

  • Patient information being more complete.
  • Diagnoses being more accurate.
  • Better data, leading to quicker and safer decision-making.
  • More convenience for patients with shorter wait times.
  • Integrated data improving the coordination of care.
  • Greater efficiencies leading to significant cost savings.
  • Fewer medical and medication errors.
  • Improved patient outcomes.

The cost savings and convenience delivered through EHRs are certainly valuable, but their positive contributions to patient care are even more noteworthy.

Predicting Mortality Rates
Studies show that EHR use yields significant clinical benefits. In one study conducted from 2010 through 2012, HIMSS Analytics and Healthgrades found that hospitals using advanced EHRs were better at predicting mortality rates.

Researchers studied 32 different procedures across 4,500 acute-care facilities, and evaluated the associated mortality rate. They then examined the hospitals’ EHR use, and concluded that those using more advanced EHRs were better able to predict mortality rates for most conditions, including stroke, heart attack, COPD, pneumonia, respiratory failure, and stomach and intestinal surgery.

Positive Clinical Outcomes
Through the HIMSS study, researchers also found that hospitals with advanced EHRs captured more patient information. And perhaps most interestingly, the mortality rates of the advanced-EHR hospitals actually improved for heart attack, small intestine surgery and respiratory failure.

How could EHRs lead to positive clinical outcomes? With improved data capture, physicians can better monitor additional patient risk factors, base their decisions on more complete information and manage patient care more effectively.

Healthcare professionals across the country are documenting lives saved thorough EHRs, particularly due to the universal anytime, anywhere access to a patient’s health record.

It’s clear that building improved care models and eliminating errors through missing, delayed or incomplete paper records have been a game-changing outcome of EHR use.

Increased Patient Satisfaction
Although physicians may not always communicate to patients the many benefits they can experience with EHRs, they have proven to be significant:

  • Efficiency is probably the most noticeable advantage, which becomes clear when patients are awaiting test results or diagnoses. Primary care physicians and specialists no longer need to contact each to obtain important information, or wait for a lab to send test results; lab results are now sent electronically to healthcare providers, and often directly to patients, as well.
  • Convenience is achieved through quicker appointment setting, as well as shorter office wait times as result of improved pre-visit communication.
  • Health improvements stem from more frequent reminders of important preventative measures, such as diabetes and cancer screenings.
  • Patient engagement often improves, especially when doctors use EHRs to educate patients about their health.
  • Increased time spent with the physician, as a result of reducing the time spent searching for charts or tracking down patient information.

When patients feel their time is respected, and understand the status of their health, they are more satisfied with the care they receive.

Successful EHR Implementation Yields Important Results
What is more important in healthcare than saving lives? By leveraging the power of EHRs, healthcare providers have the potential to continuously improve patient outcomes and decrease mortality rates, while improving the physician-patient relationship.

Implementing advanced EHRs equals a win for those on both sides of the screen.

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Survey Reveals Patients' Perspectives on EHRs

Survey Reveals Patients' Perspectives on EHRs | EHR and Health IT Consulting |

I spend a lot of time studying and understanding EHRs. I am a “superuser” within both the inpatient facility in which I have medical staff privileges, and in the private outpatient practice. I made the leap to EHRs more than two years ago, and haven’t looked back.

I can honestly say that the two EHRs I use have improved patient care, documentation, accuracy, and quality of life for me. I realize that systems vary, but I feel fortunate that I have good tools for accessing and using the EHR.

We seem to always talk about the EHR from the perspectives of the provider, facility, and the system. But what about the patient? That seems to be an afterthought in this process. How can we leverage the data that we are collecting and storing to make the patient's experience more inclusive and meaningful to improve the health or our communities?

The National Partnership for Women and Families just published a survey that demonstrates that patients also value the EHR, and are eager for more access and features in better understanding their healthcare and options.

Here are some of the key findings from the survey of 2,045 U.S. adults:

• Eighty-five percent to 96 percent of all respondents found EHRs useful in various aspects of care delivery, while only 57 percent to 68 percent saw paper records as useful.

• Patients’ online access to EHRs has nearly doubled, surging from 26 percent in 2011 to 50 percent in 2014.

• Patients want even more robust functionality and features of online access than are available today, including the ability to e-mail providers (56 percent); review treatment plans (56 percent), review of doctors’ notes (58 percent), and and review of test results (75 percent). They also want the ability to schedule appointments (64 percent), and submit medication refill requests (59 percent).

• Patients’ trust in the privacy and security of EHRs has increased since 2011, and patients with online access to their health information have a much higher level of trust in their doctor and medical staff (77 percent) than those with EHRs that don’t include online access (67 percent).

• Different populations prefer and use different health IT functionalities. For instance, Hispanic adults were significantly more likely than non-Hispanic Whites (78 percent vs. 55 percent) to say that having online access to their EHR increases their desire to do something about their health; and African American adults were among the most likely to say that EHRs are helpful in finding and correcting medical errors and keeping up with medications. Specialized strategies may be necessary to improve health outcomes and reduce disparities in underserved populations.

In many ways, the survey findings really surprised me, as this is the first time that I have seen substantial survey data about how patients see the whole process of the EHR. Their understanding of the utility of the EHR was refreshing.

Some findings raise concerns, however. Patients' desire to have more electronic access may be problematic. Think of the increased workload in responding to a new access point, and the potential for misunderstandings and conflict in care plans if diagnostic data and records can be viewed unfiltered and without the assistance of the care provider.

On the other hand, the EHR seems to provide at least some of the tools that a provider needs to improve health outcomes and reduce healthcare disparities among diverse populations. It was good to see that the EHR was seen by some ethnic populations as a way to motivate them to be healthier and to take more responsibility and control of their healthcare.

Much has yet to be learned and uncovered in the wake of the push to automate and digitalize the health record in the United States. Sometimes the law of unintended consequences can work in the favor of the healthcare system.

One fact remains for all providers, learning to survive in the post-EHR world, and acquiring the skills needed to become efficient in the use of the EHR, have never been more important. There is no going back to the paper record.

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