Health Care as if Health Mattered

EHRs can help improve quality of care in practices of various sizes but only if practices use them to change their operations.

Physicians are trained to make intellectually challenging decisions and provide complex treatments to individual patients, but the goal of maximizing health is achieved when their entire panel of patients with common problems— particularly hypertension, hypercholesterolemia, and tobacco addiction—receive simple, evidence-based preventive services with a high degree of consistency.

EHRs designed with prevention as a guiding principle can generate reminders for patients to keep appointments—reminders sent routinely by dentists, veterinarians, and auto mechanics, but rarely by physicians. Lifesaving preventive actions and recommendations can be programmed into the EHR system as the default choice instead of requiring a busy physician with incomplete information to remember them.

To improve health outcomes, prevention must be integral to EHR design. A well-designed EHR ensures that clinicians have key information at the right time and in the right format to make decisions about the care of their patients before, during, and after clinical encounters

EHRs require standardized data elements to allow comparison of key indicators across physicians and practices as well as electronic interfaces with laboratory results and medication histories.

EHRs with registry functions enable clinicians to know exactly who has which conditions, who is due or overdue for key screenings, whose illnesses are well or poorly managed, and where they need to improve care.

Effective use of an EHR for prevention and for incentive payments will require that practices change workflows, both to record the data necessary in a consistent manner and to systematically improve preventive care. Gains in the quality of preventive care and management of chronic disease take place when protocols for services are established, rigorously followed, and continuously monitored with individual feedback to physicians. In most physician practices, this will require altering office assignments and workflows, as well as retraining staff and possibly hiring additional staff.

Physicians will make these changes only if they are enabled by EHRs and supported by pay-for performance financing.

Health Insurers Collaborate With Providers to Develop Pay-for-Performance Standards for Specialists - http://www.aishealth.com/Bnow/hbd031808.htmlhttp://www.aafp.org/online/en/home/publications/news/news-now/professional-issues/20071016pcpcc.html

Bridges to Excellence Launches Medical Home Program - http://www.bridgestoexcellence.org/Content/ContentDisplay.aspx?ContentID=119

Top U.S. Health Benefits Companies Join Physicians, Employers, Consumer Groups to Support Patient Centered Primary Care Collaborative - http://www.earthtimes.org/articles/show/news_press_release,198801.shtml

Aetna Statement In Support Of Patient-Centered Primary Care Collaborative - http://www.tradingmarkets.com/.site/news/Stock%20News/702205/

Major U.S. payers support Patient-Centered Primary Care Collaborative

- http://www.healthcareitnews.com/story.cms?id=7966

EVIDENCE ON THE EFFECTIVENESS OF THE PATIENT-CENTERED MEDICAL HOME ON QUALITY AND COST - http://www.pcpcc.net/content/evidence-quality

Quiet Revolution Under Way at Some Family Medical Practices - 

http://www.14wfie.com/Global/story.a...61264&nav=3w6r 

Medical Homes May Be the Healthcare of the Future - http://www.associatedcontent.com/article/441582/medical_homes_may_be_the_healthcare.html