Paulo Pinho '96
About 15 years ago, an eye-opening report by the U.S. Institute of Medicine starkly quantified the impact of medical errors, concluding that as many as 100,000 lives are lost each year to preventable mistakes. In the ensuing debate over systemic reforms, paper medical records – cumbersome at the best of times and illegible and poorly maintained at the worst – emerged as one of the health care system’s principal vulnerabilities.Medical practices in New Jersey are now making substantial progress, however, in eliminating deadly mistakes such as dangerous medication interactions and gaps in disease screenings, by replacing their paper charts with electronic health record (EHR) systems. One of the key drivers of the state’s success on this front is an NJIT-led, federally funded organization, New Jersey Health Information Technology Extension Center (NJ-HITEC) that is working with more than 8,000 Garden State providers to collect, digest, and use their electronically stored patient data.
Since it was founded in 2010, NJ-HITEC has been one of the top-performing regional extension centers, or RECs, established by the Office of the National Coordinator for Health Information Technology, the federal agency responsible for advancing health information technology and the electronic exchange of health information.
As of this month, NJ-HITEC has more advisees – 4,750 primary care physicians and specialists – able to demonstrate they are using their systems in a meaningful way than any other REC in the country. The federal government defines “meaningful use” as the collection and storage of key data such as symptoms, vital signs, and other health metrics that the system can then act on intelligently, as in calculating a body mass index or creating a growth chart, among other measures. By inputting this data, as well as the treatment course they followed, doctors are also able to evaluate their patient’s performance on key clinical measures against national guidelines the EHR system provides.
“Our mission is to transform the health care delivery system in New Jersey by implementing technology that will enhance the delivery of high-quality, timely care,” says William O’Byrne, NJ-HITEC’s executive director. “Electronic health records help us monitor drug interactions, speed up the delivery of medications through e-prescribing, reduce the time it takes to refer patients to specialists and to receive reports back from them, and, importantly, to eliminate redundant tests and treatment.”
Physicians say that electronic medical records are particularly helpful in caring for patients with chronic health problems, allowing them to keep close tabs on recommended testing.
“I can follow patients who have diabetes and check if they have had an HBA1C, (a key hemoglobin test) prior to them coming into their appointments. If not, I will contact the patient and send him or her to the correct lab so the result can be discussed during the visit. This only takes a minute and would have taken up to a half-hour on paper charts,” says Douglas Ashinsky, M.D., an internist in Warren. “This allows me to take better care of my patient during their visit.”
By creating patient registries – a patient population data set that allows population management – Ashinsky said he is able to compare his performance to regional and national guidelines for clinical care “to ensure that we are following these guidelines and giving patients the best possible care.”
“My EHR system has helped me catch both cardiovascular disease and colon cancer in the early stages by identifying patients at risk by age group and family history who had never been screened,” says Paulo Pinho, M.D., an internist in Milburn. “I may be treating that patient for a cold, but the system enables my staff to check for outstanding screenings and make necessary referrals.”
Pinho said he has increased the percentage of patients in his practice with an average risk for colon cancer who have been screened for the disease and the results documented in the electronic record, from 5 percent to 90 percent between 2009 and 2013. The low number, he said, included patients who may have been screened but for whom the office had either no documentation or were untrackable due to mislabeling. The comparable national figure is 53 percent, he notes.
Medicare will begin penalizing practices that cannot certify they are meaningfully using electronic health records by 2015.
“Many New Jersey practices have already moved on to the next stage of EHR implementation, defined by health IT regulators as Meaningful Use Stage 2, by exchanging information with other health care providers so their patients transition safely and successfully to other phases of care, and by allowing patients to view their own records electronically through patient portals,” notes Balavignesh Thirumalainambi, NJ-HITEC’s meaningful use director.
In the final stage of the process, Thirumalainambi says, EHR systems will assess providers’ adherence to evidence-based treatment standards and will assist them in their clinical decision making to improve the quality of healthcare, thereby also reducing the cost of care.
“As the system evolves, we will also see more interoperability among providers that will improve both safety and efficiency,” says Pinho, who is currently working to create a ‘virtual exam room’ that will allow patients, their family members, and all of their doctors to review their records to better coordinate care, including cross-checking medications and eliminating duplicative testing.