Report from AMIA: Beyond Electronic Versions of Paper Charts

The impact of meeting meaningful use requirements is one of the hot topics at this year’s Annual Symposium of the American Medical Informatics Association in Washington, D.C.

In an Oct. 24 session, Len Bowes, M.D., a senior medical informaticist for 22-hospital Intermountain Healthcare in Utah, described the difficulty his nonprofit organization is having with changes around its homegrown electronic health record (EHR) and CPOE. The effort has required both software and workflow changes that are taking longer than expected. Intermountain decided to postpone its hospitals’ attempts to achieve Stage 1 until mid-2013. “If we get half of our hospitals to achieve meaningful use then, it will be good,” Bowes said.

On the other hand, some other integrated delivery networks experienced with clinical information systems question the value of meaningful use to their organizations. Amy Compton Philips, M.D., associate executive director of quality for the Permanente Federation, which represents the national interests of Kaiser Permanente's eight Permanente Medical Groups, said meaningful use is great for the country at large, but it is “doing things we were doing 10 years ago. It is requiring us to do some work crossing I’s and dotting T’s that we’re not certain adds value.”

On the same panel, several presenters spoke about ways their organizations are moving beyond digitizing paper records and processes to use IT tools in a more sophisticated way.

Mary Goldstein, M.D., director of the Geriatrics Research Education and Clinical Center at the VA Palo Alto Health Care System, described her team’s work developing a clinical decision support system for hypertension management known as Athena CDS. It combines patient information from the VistA EHR with an automated knowledge base about hypertension to generate patient-specific recommendations for managing hypertension.

Michael Kanter, M.D., medical director of quality and clinical analysis for Southern California Permanente Medical Group, talked about how IT systems are at the heart of an effort to make office encounters more proactive. “We are embedding processes to support preventive and chronic care needs into standard workflows, and utilizing IT tools for identification of patient care gaps,” he said. Physicians and medical assistants develop and sign team agreements about which tasks each would do before, during, and after office visits. The computer system scours the patient records and comes up with a checklist specific to the patient, such as when to order lab tests. The medical group measures and provides feedback on how each office is doing. Kanter said screening levels are up considerably since the program’s inception a few years ago. “We are activating all members of the healthcare team in providing a proactive patient care experience, and the patients really notice,” he said. “It helps create a partnership between the patient and the health team.”

Paul Tang, M.D., chair of the Meaningful Use Work Group of the Health IT Policy Committee, spoke on a panel about clinical quality measure development. Tang described the challenges of creating clinical quality measure concepts for Stage 3 when the measures themselves don’t exist yet. Proposed core measures, he said, could deal with medication reconciliation and closing referral loops. Others may deal with the patient experience itself, such as patient and family experience of care across transitions of care. Still others may be longitudinal to track how well providers are helping individuals over time. “That is a different mindset for quality measurement,” Tang said. “Clinical quality measures will be a focal point for health care delivery and payment. We need to develop clinical quality measures that are meaningful to clinicians and patients and captured as a byproduct of care.”