Integration and prioritized data essential for EHRs

AN EMERGENCY ROOM DOCTOR doesn't need to know a hemorrhaging patient is due for a flu shot. The discharge nurse doesn't need to know the patient's father has high blood pressure. A family physician, however, might want to know all of the above. Electronic health records (EHR) can contain reams of information, but sifting through that data to find relevant information clinicians need at specific times can counteract much of an electronic system's time savings.

"It could be a serious problem," says Jim Walker, MD, chief health information officer at Geisinger Health System in Danville, Pa. "There is almost no discussion nationally about how EHRs should be integrated with how nurses, care givers and doctors work."

While experts agree that electronic records in any form save time and increase patient safety, how EHRs are implemented and integrated can make all the difference.

COLLECTING DATA TO PRESENT

Creating an optimal EHR requires data from different sources be presented in a way that not only helps the right person in the right place, but that allows the person to consider the source of the data. Claims data, patient-generated information, questionnaire responses, and notations from doctors and nurses all need to be considered.

"Claims data doesn't reflect clearly enough what happened to the patient in order to be useful for most purposes," Dr. Walker says. "For example, you have a patient with heart failure who is on an ACE inhibitor, but he develops a cough when taking it. That kind of thing won't show up on claims data. A doctor may see the patient's not on it and wonder why he isn't."

In the future, claims data may become much more detailed in order to streamline the flow of good data into electronic records. That's important because too much data can hurt the quality of care, so an EHR system must be designed to collect good information and route that information to the people who need it. Detailed claims data could become an integral part of that good information.

GIVE THEM WHAT THEY WANT

In a hospital inpatient situation, doctors and nurses should be able to quickly access data regarding that hospital stay, such as the patient's physical, progress notes, nurses' notes, lab tests and radiology, says Ury. But hospitals also need to know any other medical problems and what medications the patient is taking.

Geisinger Health System-which is comprised of two medical centers, three hospitals and a 720-member group practice-has spent 12 years and $90 million developing its information technology infrastructure and EHR. While it's constantly looking for ways to improve, its system is tailored to different caregiver situations.

"If one of our outpatients is admitted to the hospital, the first thing the hospital caregiver will see is a list of existing patient problems, then an outpatient medication list," Dr. Walker says. "They can click buttons to change medications as needed. They also see medications every day as they make their rounds. Then at discharge, they see both before and after medication lists. They can see what medications resume, what is being replaced, what is new and what should not be taken. Those lists can be printed for the patient and the patient can access them online."

On the outpatient side, clinicians need access to the full electronic health record, Ury says.

"They're interested in progress notes, problem lists, immunization status, medications, family history and more," he says.

A physician's office might want a summary of a hospital stay and discharge medications, but doesn't need to know every detail of a hospitalization-for example, the blood pressure readings taken every eight hours.

Emergency room doctors and nurses have the most critical needs for finding specific EHR information quickly and efficiently.