Question

Define and discuss with your understanding of integrated healthcare information systems, and how it will shape the future

Answer 1

Using Electronic Health Records to Help Coordinate Care

Lynda C Burton, Gerard F Anderson, and Irvin W Kues

Additional article information

Abstract

The use of electronic health records that can securely transmit patient data among physicians will help coordinate the care of 60 million Americans with multiple chronic conditions. This article summarizes the different organizations in the United States that are developing this technology. It discusses some of the problems encountered and the current initiatives to resolve them. The article concludes with three recommendations for enhancing care coordination: (1) a common health record, such as the Continuity of Care Record, to facilitate the exchange of clinical information among health providers; (2) regional governance structures to encourage the exchange of clinical data; and (3) payment by purchasers of care, both public and private, to physicians for using electronic health records.

Appropriate medical care for people with multiple chronic conditions requires that clinicians be able to communicate with one another about their patients. Unfortunately, in today's medical care system, many clinicians are unable to communicate easily and efficiently with their colleagues. In a series of reports, the Institute of Medicine (IOM) named ineffective care coordination as a cause of poor care and initiated a series of reports recommending electronic health records as one way of improving its quality (Institute of Medicine 2003b; Institute of Medicine, Board on Science Technology 2001). The greatest burden stemming from this lack of easy and effective care coordination is for the 60 million Americans with multiple chronic conditions (Anderson and Knickman 2002).

Studies have found that people with multiple chronic conditions are more likely to be hospitalized, see a variety of physicians, take several prescription drugs, and be visited at home by health workers. For example, Medicare beneficiaries with five or more chronic conditions fill an average of 48 prescriptions, see 15 different doctors, and receive almost 16 home health visits during one year (Partnership for Solutions: Better Lives for People with Chronic Conditions 2002a). Furthermore, the poor coordination of care has been associated with poor clinical outcomes such as unnecessary hospitalization, duplicate tests, conflicting clinical advice, and adverse drug reactions. One study showed that Medicare beneficiaries with four or more chronic conditions were 99 times more likely to have an unnecessary hospitalization during the year than was a beneficiary without a chronic condition (Wolff, Starfield, and Anderson 2002). All this suggests a need for better care coordination and information sharing among clinicians. The growing evidence attests to the value of electronic clinical data systems in bringing better care to persons with multiple chronic conditions (Casalino et al. 2003).

A major step in promoting care coordination is the electronic health record (EHR). The EHR enables clinicians treating people in a variety of settings to exchange and continuously update a patient's clinical data and then present that information in logical clinical groupings that other clinicians can access easily. The key functions of an electronic health record system outlined by an Institute of Medicine committee are health information and data storage, results management, order entry and management, decision support, electronic communication connectivity, patient support, administrative processing, and reporting and population health management (Institute of Medicine 2003a). Such an integrated system allows a physician to enter a patient's record number and view a menu showing his or her current medications, problem list, history of recent visits to health providers with submenus for notes from those visits, images and reports of diagnostic procedures, a functional status assessment and social service eligibility report, schedule of preventive services, allergies, contact information for all persons caring for the patient, names and contact information for family caregivers, guidelines for appropriate care, and clinical decision support.