Health Care Technology
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Cooper Clinic Chief Medical Officer and preventive medicine physician Michele Kettles, MD, MSPH, explains the benefits of health care IT for patients and health care providers as well as the implementation of The Information Blocking rule under the 21st Century Cures Act.
Improving patient care with technology
A broad definition of health care information technology (IT) encompasses any time physicians interact with technology to augment or improve how we deliver health care. Certain technologies—like blood pressure monitors or thermometers—have become much more sophisticated since those were our only tools. Today’s health care IT typically refers to the software programs used to deliver care and share information with patients and other physicians or health care entities.
One of the main concerns when transitioning to electronic medical records at Cooper Clinic was ensuring a way to efficiently, reliably and continuously store medical information. Historically, facilities only kept patients’ medical records for seven years due to the practicality of storing that amount of paper. Electronic records became the solution which allows us to store close to an infinite amount of information.
Physicians are able to analyze information about a patient a lot differently electronically as opposed to rifling through a ton of paper. One of my favorite things about having electronic records is it enables me to find trends in my patients’ health. You can detect trends in everything from blood pressure and cholesterol to fitness and heart plaque scores. For example, something tested can be considered within normal range with each doctor’s visit, but if a patient’s total cholesterol is 130 one visit and 190 the next, while both are considered within normal range, when you look at that trend over time you understand it is not normal for them as an individual. With this insight, I have a fuller understanding of my patients’ health to better guide how I treat them.
Embracing health care IT
Health care IT is not designed solely for physician use but patients as well. Patient portals are one of the most important and beneficial health care IT tools on the patient-facing side of health care. However, one of the problems with patient portals is health care providers utilize different software. For instance, your gynecologist, your cardiologist and the hospital where you may have had surgery may all use different patient portals. When Cooper Clinic was exploring patient portals, we were most interested in having one that provided a single place for patients to store all of their health records.
The goal for medical information to have a single access point for each physician not only improves the quality of care provided but also helps reduce redundancy. I can’t tell you how often I need to run a test on a patient and they think they’ve already had that test but are unsure of where and when it was performed or its results. At this point, we must spend hours trying to track down the test information, where we would ideally just log into a master portal to find all that information allowing us to efficiently make an informed decision about how to move forward. Health care IT will only get more robust and effective as time goes on.
I would like to see patients have access to their own personal medical vault, so to speak. This technology would enable them to submit and review their records as needed with easy accessibility as well as allow their physician to sign into it to access their records.
I have long been interested in electronic patient records so in 2006 I volunteered to be one of the first physicians at Cooper Clinic to make the transition from paper to electronic. Our more tech-savvy physicians, who were interested in the system, transitioned to electronic patient records first, which gave us a chance to work out the kinks before bringing everyone else on board. Being involved in this process motivated me to become board certified in Clinic Informatics. That time period was considered early adoption of electronic medical records because the vast majority of facilities were still paper with only 10% of practices going electronic, most of those being large hospital systems.
As with any software, regular updates are necessary. Approximately every two years health care IT software updates are made and new functionalities are introduced. Typically not an easy process, the updates usually involve some downtime for the health care facility and require a group effort. When routine software updates are conducted at Cooper Clinic, we not only have to make sure the main piece of software is properly updated but that each of our departments’ interfaces properly connect to it as well—which requires a great deal of testing to ensure each departments’ technology is intact.
Our electronic medical record system is vital to our doctors and clinical staff. It provides an efficient way to store and search for information as well as look at patient’s health trends over time. Now with one central location for our patients’ information, I’ve had to find new ways to get my steps in since I’m not walking all over the building to get my patients’ results. All joking aside, our electronic medical records system has changed the trajectory of how we practice medicine.
Information blocking and the 21st Century Cures Act
The 21st Century Cures Act was signed into law in 2016 to help accelerate medical product development and bring new innovations and advances to patients who need them faster and more efficiently. The Cures Act is a very broad set of laws and regulations for the health care industry, but has recently been in the spotlight with the information blocking piece of the act going into effect in April 2021. This specific clause of the Cures Act essentially prevents patients and other physicians from being blocked from receiving one’s medical records. It is not referring to health care providers intentionally withholding information but rather the software program limitations that make it difficult for a patient or physician to obtain the information needed.
How does information blocking happen? Many software programs are proprietary, so companies do not want to have an open interface where competitors can see and duplicate their product. What started out as private companies wanting to have a valuable product they have market control over, ended up causing roadblocks to accessing information. The Cures Act is driving patient portal software to be more user-friendly by making their information more easily accessible. Ideally a patient would not even have to call their doctor for their information because they would already have all of their records at their fingertips.
Historically, physicians have only given patients information they deem relevant rather than providing their entire medical records, which would be like handing them a phone book because each record contains so much information. While this came from a place of good intentions of not wanting to bombard patients but only provide information the physician felt was most beneficial, this practice unfortunately led to patients not receiving certain information they should have. Thus the Cures Act also specifies the information a physician must share with the patient. For example, health care providers are now required to give the patient all progress notes, lab results and radiology imaging results. These are types of information a physician would typically share with patients during their visits but wouldn’t provide a physical copy of.
The way doctors previously shared information with patients was designed to make the information more digestible for the patient but inadvertently ended up blocking other pieces of useful information. The definition of what will be shared with patients will continue to expand to encompass their entire medical chart. As physicians comply with the information blocking rules of the Cures Act, the challenge will now be determining the best way to share a patient’s information with them in an organized and approachable way while still sharing the entirety of the information.
Enabling higher quality care
While the Cures Act is certainly aimed at patients, it will also prove beneficial for health care providers. For example, I recently saw two female patients both of whom had bone density tests elsewhere but couldn’t remember exactly when the test was taken or their test results. This is information that would be helpful to have direct access to so I could treat them appropriately and not have to repeat the tests.
In medicine, there is never a day where I am working with too much information. My job is to sort out what matters most so if I can access all the information I need about a patient in one place, I can take better care of them. Ultimately this also benefits the insurers. If I order the bone density tests of the patients previously mentioned and it wasn’t necessary, someone has to pay for the test to be done again, whether it is the patient or the insurer, and those become wasted dollars that could’ve been spent on something useful for someone else.
When you eliminate the gaps in someone’s care plan, you are not only able to provide better care but also reduce redundancy and health care cost. With new health care IT emerging and regulations such as the Cures Act implemented, patients’ health needs can be met with more precision, speed and efficacy.
Article provided by Michele A. Kettles, MD, MSPH, Chief Medical Officer and preventive medicine physician at Cooper Clinic.
To learn more about Cooper Clinic preventive exams, visit the Cooper Clinic website or call 866.906.2667.