According to the TennCare website, the definition of Meaningful Use involves using certified EHR technology to

· Improve quality, safety, efficiency, and reduce health disparities,
· Engage patients and families in their healthcare,
· Improve care coordination,
· Improve population and public health, and
· Maintain privacy and security.

Remarkably, we have already seen first-hand examples of Quillen ETSU providers and clinical staff using our EHR to each of these ends. 

Addressing health disparities has been the primary  focus of the patient lists generated for each provider. Many of the family medicine and internal medicine providers now have access to a list of all their diabetic patients with records in the EHR. 

These lists help providers and clinics manage this patient population, who, in Tennessee, had a 19% higher risk of dying from diabetes than the national average.  The Tennessee diabetes death rate of 30.2 per 100,000 was ranked 10th highest in the nation in 2002. In 2004, the age-adjusted diabetes death rate for black Tennesseans (61.1 per 100,000) was over twice the rate for whites (27.8 per 100,000).* 

*Information from tn.gov. 

Each of the Quillen clinics has also been offering  Clinical Summaries to patients and/or their family members at check out.. While not every patient asks for the summary, some patients have found these summaries very beneficial, such as parents wanting the most up-to-date immunization record, or simply patients who are on multiple medications.  

As we look toward adding a patient portal, patients will gain even more access to their health records, and, hopefully, this will prompt many of them to become more engaged in their own healthcare.

Improving care coordination has been one of the biggest benefits of using the system. With multiple providers and specialties having quick access to the patient’s chart, duplicate labs and medications have significantly decreased, saving patients money and time.

The referral process to providers within ETSU clinics has also  been significantly improved. Faxing records is no longer necessary, and clinics can use tasking rather than phones and faxing to make the referral.

With the system’s ability to track and report data, we are now able to run reports on various population and public health initiatives. In the Department of Pediatrics, data has been requested to track abnormal labs, the Read N Play initiative, and reflux diagnoses. In the Department of Family Medicine, various information is being tracked for improvement of their Patient-Centered Medical Home designation, as well as monthly reports on Controlled Substance prescriptions.

The system is also designed to generate reminders based on either input from individual providers or as system-generated reminders based on recommended screening and diagnostic guidelines, such as colorectal cancer and mammography screenings. Recently, reminders have been set up for CSMD checking  for patients on controlled substance prescriptions.

Maintaining privacy and security has always been a top concern for EHR users, no matter what the system. With retail electronic security breaches being reported regularly, many healthcare providers questioned the security of electronic health records when EHR systems were first introduced into practices. However, with quickly evolving technologies, and the stringent requirements on systems in order to be certified for Stage 1 of Meaningful Use, EHR systems are exceptionally secure. Eligible providers need to “attest” that they have met certain measures or requirements regarding the use of the EHR for patient care. 

EHRs are more secure than most paper charts ever were, especially within organizations where chart audits are frequently performed. In the paper world,  if an employee wanted to access a health record without reason, most likely, no one would ever know if he or she  had been in the record. With electronic records, anyone who accesses a chart is trackable, resulting in a more secure health record.

As we all become better users, the possibilities for how the system can be used in more meaningful ways will be illuminated.

What makes a medication meaningful? I suppose that ANY medication that is prescribed to a patient should be meaningful, but what happens when a patient’s medication list is maintained on the EHR, but the list isn’t accurate? Would an incomplete or inaccurate list be meaningful to anyone?

Let’s for a moment suspend the idea of a medication’s “usefulness” to the patient and examine the “meaningfulness” of the medication’s inclusion on the medication list. Perhaps the best way is to present a few patient scenarios:

Patient Scenario One

Patient One, “Mary Meaningful,” visits a clinic because she has allergy symptoms. She currently takes an over-the-counter decongestant, as well as a few vitamins and supplements. She also takes an anti-anxiety medication that she asks not be included on her medication list. Not wanting to cause Mary any distress, the nurse records her medications in the system (absent the anxiety medication) and sends her on to see the provider. Mary doesn’t mention anything about the anxiety medication to the provider because she feels embarrassed that she is taking it. The provider feels sure the medication list is accurate because it has been reconciled by the nurse and prescribes Mary an antihistamine.

Do you see the potential hazard here?

Dangerous interactions can occur when antihistamines and anti-anxiety drugs are taken together.

Patient Scenario Two

Patient Two, “Mike Meaningful,” shows up for his annual Medicare visit. He reports to the nurse that he has been seeing one of the cardiologists for some heart-related issues and that he was prescribed some medications a few months ago. She pulls up his chart and doesn’t see any medications on the list. When she questions Mike, he tells her that the doctor was too busy at his appointment and didn’t have time to put them in the system.  He just wrote them out on prescription paper.

How meaningful is the medication list now?

One provider’s responsibility has now been pushed off to another provider’s clinical staff, and, consequently, takes more time and is potentially less accurate than using the system the way it was designed.

Patient Scenario Three

Patient Three, “Misty Meaningful,” was originally prescribed 25mg of a blood pressure medication by her primary care physician, which was ordered through the system correctly. A few weeks later, Misty’s blood pressure hasn’t improved so the clinic calls in a higher dosage—50mg—but doesn’t record the change in the patient’s chart. Misty visits her specialist, who sees the dosage is 25mg but knows she is taking 50mg, as she reported to him. He decides she needs to take 100mg, and renews the medication at the higher dose. Unfortunately, Misty has a bad reaction and files a malpractice suit. When the defense attorney reads the specialist’s note, it appears that he upped her dosage by 75 mg because no one recorded the 50mg.

Where does the fault lie? 

Obviously, no one could have predicted the bad reaction, but how can we rely on the accuracy of a medication list and the system’s ability to accurately reflect a provider’s plan when no one takes the time to document in the EHR?

Meaningful Medications = Better Patient Care

I could describe many more patient scenarios in which the lack of accurate medication documentation has caused problems, but I think you get the point. Even when clinics were on paper, keeping an up-to-date medication list was very important for good patient care, but now, with the transition to an electronic health record, and with multiple providers using the same chart, each user must be particularly careful to accurately document. If we strive to make the medication list truly meaningful, the end result can only mean better patient care.