EHR Dr. Jason Mitchell's Health IT Story

Health information technology plays a key role in family
medicine to enable family physicians
to provide high-quality care effectively, and coordinated
care within their practice. The volume of health information around an individual patient is exponentially increasing, and the complexity
of medical knowledge that has to be applied
to that data is also expanding exponentially. And so health information
management tools that can be applied
at the point of care are really essential
to be able to provide, again, that high-quality, safe, and efficient and effective care
to patients. Family physicians face the same
types of problems that all physicians face
in dealing with electronic health record
systems, in particular.

Certainly, the amount of time
that it takes to evaluate an appropriate
system, to customize that system
to your needs, and implement that effectively
in your practice is significant. The cost of electronic health
record systems has remained very high,
even over the last 10 years. And then, also, the complexity
of bringing an electronic health record
system into your practice. It really is a practice
transformation, to use an EHR effectively.

You can't really do it little
bit by little bit. It's got to be done on a fairly
large scale at one time. So the complexity of managing
that, dealing with that, the changes that it creates
in a practice, are all significant barriers and
issues you have to work through. We would like to think that,
at the AFP Center for Health IT, that we're able to provide
a process for primary care physicians to apply and to use
to get through that.

The educational background
and preparation is really, really important. It's a key element
that has to be there. Setting expectations around what
the electronic health record is really going to do
within a practice. There seems to be this concept
that you just flick the switch, turn the thing on,
and high-quality, safe, and efficient medicine
suddenly appears.

And that is not the way that
electronic health records work. And so the educational component
is key. A lot of what the Regional
Extension Centers are now doing is a key element of bringing
electronic health records successfully into primary care
practices. And then also efforts
of getting doctors to communicate with each other
about their successes.

Getting groups of doctors
talking about what they've done, what systems they're using, what
work flows are working for them, I think have all been
key elements in expanding the use of electronic health
record systems. Electronic health record systems
can really help to put more focus on the patient
around the care that they need and improving the quality
of the care that they receive. There is a component of
engagement that is much greater with the use of electronic
systems than we currently have
in our paper-based process. Using portals, so a patient can
log in and have access to their record, their lab
results, their problem list, they can validate that that
information is accurate.

And so all of these things,
I think, engage patients more effectively
in an electronic world, as opposed to
the paper-based world. And then care coordination,
I think, is really the key element
for patients. Being able to bring the
disparate health care process together around
that individual patient to make sure that there isn't
redundancy in their care, to make sure that there aren't
dangerous drug interactions, to make sure that each of the
providers that is necessary to be involved
in that patient's care is on the same page and is
working towards the same goals. That's much more effective
with an electronic system than, again, our current
paper-based process.

"Why aren't you using one?"
Would probably be the first question that I think
a patient should ask. There are proven benefits from
the quality and safety aspect around electronic
health record use. And I think that patients should
expect physicians to be using electronic health record systems
in their practices. My 80-year-old grandfather came
over from England to visit a couple of years ago
and came into my practice, and the first thing he asked
was, "Where are the computers?" We weren't using an electronic
health record system at that time,
and he was shocked.

He lives in a small town
outside of -- in a rural area of England. And his general practice doc has had electronic health
records for a long time. It's his expectation, and I
think it's an expectation that the U.S. Should have,
as well.

Patient care will be affected
in a number of ways. But I don't think it's
electronic health records that are really the issue around
how things are going to change. Electronic health record systems
are a tool. And the way that physicians
use those tools is what's going to impact
patient care.

And so, if we use them
meaningfully and expand the definition of
that over time, then I think we'll see
significant improvements in the quality of care
that's delivered, the coordination
of care that's delivered, potential reductions in the cost
of care that's delivered, and the satisfaction of the care
delivery experience will go up, both for
providers -- physicians -- and for patients..