The patient-centered medical home is an emerging trend in the effort to provide comprehensive primary care. But how has the current generation of electronic health records (EHRs) supported (or hindered) care coordination efforts such as medical home pilot projects, and what are the implications for future meaningful use requirements?
Those are among the questions the federal Health IT Policy Committee Meaningful Use Workgroup took up in a public meeting on Thursday, Aug. 5. The presentations and discussions will help shape the Policy Committee’s recommendations for stages 2 and 3 of meaningful use goals.
Among the presenters was Ann O’Malley, M.D., M.P.H., a senior researcher at the Center for Studying Health System Change, a policy research organization based in Washington, D.C. Her group interviewed 60 physicians, nurses and staff from 26 practices in 12 communities across the country on this topic, and O’Malley summarized the results for the workgroup.
Although they described immediate access to data at the point of care and electronic messaging within an EHR as helpful for coordination tasks, respondents were unhappy with the lack of widespread standards for data exchange and poor interfaces between systems, as well as EHRs’ lack of functionalities to support key coordination tasks, O’Malley said.
Clinicians said that current EHRs do little to facilitate collaborative decision making among different clinicians caring for the same patient, she said. They also stressed the lack of financial incentives for inter-specialty coordination, noting that until reimbursement changes, care processes and the EHRs supporting them will not prioritize coordination.
O’Malley said that in stages 2 and 3, more complex elements of coordination might be addressed, such as shared care plans and “service agreements” that define common expectations about how primary care and specialist physicians will exchange information and delineate care responsibilities.
Another presenter was Peter Basch, M.D., whose seven-physician primary care practice in Washington, D.C., is part of a regional patient-centered medical home pilot project. He noted that even the best provider-facing EHRs support the existing paradigm of care and care documentation by a sole provider.
Basch said an EHR transformed to support actual care coordination would offer the ability to easily attribute multiple providers to a patient, and to use that attribution to create virtual care teams and to enhance those care teams’ work. He said EHRs should also allow for the creation, sharing and modification of care plans between providers and patient.
Paul Tang, M.D., vice president and chief medical information officer with the Palo Alto Medical Foundation in California and chair of the workgroup, noted that 2013 might be too soon to require some of these suggested features because vendors need time to build them into their systems, but added that the panelists had done a good job of putting their finger on what is missing from the current generation of EHRs.
(An upcoming story in the September issue of Healthcare Informatics outlines other issues the Health IT Policy Committee will soon grapple with for stages 2 and 3 of meaningful use.)