In 2005, New York City Mayor Michael Bloomberg announced a new initiative under the NYC Department of Health and Mental Hygiene (DOHMH) to use innovative technology to improve health in disadvantaged areas of the city. To fill this mandate, the city created the Primary Care Information Project (PCIP), a $27 million city initiative to use technology to improve the quality and efficiency of healthcare throughout the five boroughs On Feb. 7 at the New York Institute of Technology in Manhattan, key industry leaders spoke about how New York City has improved health through technology.
The use of technology has led to improvements in detecting certain preventable health problems, including high blood pressure, tobacco use, high cholesterol, and diabetes. With the help of electronic health records (EHRs), 81,000 patients improved their management of diabetes, 96,000 New Yorkers got help controlling their high blood pressure, and 58,000 smokers got help kicking the habit.
The conference began with Mayor Bloomberg speaking admiringly about the strides made in health IT, specifically noting how EHRs have improved both the length and quality of people’s lives. Bloomberg stressed that computerizing medical records is only part of it; transforming how doctors use those records to improve care is the next step. “We’ve always said if you can’t measure it, you can’t fix it. But it’s also true that if you don’t look at the data you have, you are wasting an awful lot of money.”
The success of the PCIP has inspired a national initiative to introduce EHRs to medical providers across the country as a way of improving the quality of care. The Office of the National Coordinator for Health Information Technology (ONC) has funded 62 Regional Extension Centers (RECs) to help more than 132,000 primary care providers adopt EHRs, said Farzad Mostashari, M.D., national coordinator for health IT. "More than 40 percent of all primary care doctors across the country are working with the RECs to adopt EHRs. And, with the help of federal incentives, more than 80 percent of the nation’s hospitals and 65 percent of eligible doctors have signed on to be meaningful users of EHRs."
Mostashari added, “Every person here who has worked on [this initiative] has saved lives, but we will never know who they are. You can put a name to the face of a surgeon who helps save someone who has a stroke or heart attack. But if you prevent that stroke or heart attack, you never get credit for it. That is the power of public health and data.”
It comes down to the belief that healthcare can and must be better, he continued. “Every day technology is getting faster, better and smarter, and there is an intrinsic sense of optimism that comes from technology. This is the transformational advancement of our age. But you need to embed that technology within new workflows, new processes, and these are things we never did before.”
Thomas Farley, M.D., health commissioner of DOHMH, agreed with Bloomberg and Mostashari that while EHRs are making a big difference, people must remember that they are just tools. “Just as a scalpel won’t do surgery by itself, an EHR won’t do quality of care by itself. The care is only improved if providers are using the data intelligently to change how they practice.” PCIP does its part to help providers do that, Farley continued, noting that they offer quality dashboards, which go to 450 practices. On-site technical assistance about how to change office practices to improve these preventative services is also offered. “We are transforming medical care in New York City, and that is the bottom line.”
The results achieved already with EHRs are far beyond what Thomas Frieden, M.D., director of the U.S. Centers of Disease Control and Prevention (CDC) ever could have imagined. There are critical lessons that have been learned concerning what works and what doesn’t, but ultimately, EHRs can save lots of lives if they are done right, he said.
Between 2002 and 2005, CDC tried to improve the quality of clinical care in a variety of ways, but frankly, it didn’t work, said Frieden. “We then said ‘let’s try using the power of information. Let’s use EHRs with prevention as the default value.’” Now, through the meaningful use initiative, there is better detection and response to outbreaks. There are better immunization rates, in terms of doctors having access of immunization records of their patients, so they can find out who is missing immunization and who is in danger of duplicating immunization. Information can be used from emergency departments to track what is happening in the community. Within the PCIP program, Frieden said, “It is apparent that if you have a big enough, standardized EHR system, the information pulled from that system may match very closely with the community health data that otherwise is very difficult and expensive to get. You can get information in real time and use it to improve programs and figure out what is working, and fix it if it’s not. This could be the next big thing in health.”
The conference also included case studies from Vincent Jarvis, M.D., whose eQuits success story helped thousands of smokers quit, and Frank Maselli, M.D., who described how his Riverdale Family Practice has transitioned from paper-based charts to an EHR. But perhaps no moment captured the day’s essence more than when Amanda Parsons, M.D., DOHMH deputy commissioner, responded to those who have complained about EHR difficulties. “When I hear that, I ask them what they thought about marriage and children,” she said. “Anything that is worth doing is hard.”
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