This month I am rotating through the NYC Department of Health and Mental Hygiene at the Primary Care Information Project. This NYC Mayoral Initiative seeks to improve the quality of care in underserved communities through the use of health information technology. It has been a terrific opportunity for me to learn and reflect upon how health information technology can transform medicine by broadening its scope while narrowing disparities.
The national policy groundwork for EHR adoption began in 2009 with the Health Information Technology for Economic and Clinical Health (HITECH) Act. This granted HHS the authority to establish programs to “improve health care quality, safety, and efficiency” through the promotion of health IT. Under this act, health care professionals and hospitals qualify for incentive payments when they adopt EHR technology and achieve specified objectives. Meaningful Use refers to the set of standards defined by the CMS and the goal of these standards is to promote use and spread of electronic health records in a way that improves health care in the United States. CMS defines the benefits of meaningful use of EHRs as 1) complete and accurate information, 2) better access to information, and 3) patient empowerment.
Still, policy is always 10% legislation and 90% implementation. The burden of implementing health information technology is on health care providers. Because of this, I am not too worried about the future of health IT adoption. As a provider who trained in an age where I would not even plan a baby shower without the arsenal of a smartphone and multiple search engines, it is unlikely that as a future pediatrician, I would manage the care of a newborn without the expectation that I would have all the health information technology at my disposal to provide the best care I could. Medical students have traded in their laminated cardboard anatomy flashcards for point and zoom electronic programs on their iPods and expect to be able to retrieve patient information that they need… immediately (at least as quickly as they retrieve movie times or restaurant reviews). Change is coming because the agents of that change are entering the health provider workforce.
Instead, we must focus on the transitional era that we currently occupy, the financial and resource heavy barrier of implementing EHR systems will certainly exacerbate health disparities between practices with and without the resources to make this happen. Arguably, these practices are the ones who would benefit from a robust EHR system the most.
The true beauty and promise of health IT, stripped down to its elements is that medical professionals will have access to a system that will allow them to manage information. In medicine, organized information is key to diagnosis. In an increasingly complicated provider system where patients switch from provider to provider, health information technology provides doctors access to a comprehensive patient history and the potential to organize and store information in a much powerful way than paper file folders can offer. After all, eighty-nine percent of diagnoses can be made from a patient history-gathering interview alone, demonstrating that timely and accurate information saves lives.
Beyond the potential for improving patient care at the individual level, the Primary Care Information Project demonstrates the enormous potential of what EHRs can do to improve population health. In the past, departments of health relied on periodic surveys to gather data on epidemics and the health status of the city. With EHRs providing de-identified data at the practice level, we are able to keep our finger on the pulse of the city and respond appropriately at a much more effective level. PCIP’s dedication to implementing EHR systems in neighborhoods that would have not been able to afford it on their own, allows them to remain connected to the rest of the city and to the rest of the world. Whether a tree falls in the Bronx, Brooklyn, or Manhattan, it is important be able to hear it. Every week, we let doctors and providers know what is “going around,” giving them the opportunity to generate differentials that are informed and timely. We are able to identify practices that are struggling or succeeding at managing certain chronic diseases and to offer appropriate support or identify best practices. Medicine’s uniting objective is always “better,” and it is exciting to almost be a doctor in a world with so many new instruments to make that happen.