EHR Dr. Kim Dunn's Health IT Story

We're one of four Regional
Extension Centers in Texas. All four collaborate
very regularly. And all Regional Extension
Centers in Texas, what we're doing is, we are really focused
on enhancing the primary care practitioner's
practice, with health IT being a way to support
improving their practice. So we go out, we assess
the practice, look at their work flow, look at what
three or four technologies might work for them, help them to develop a plan, work with the vendors
to make sure that there's no "gotchas"
in terms of cost, or any other impediments
to their implementation.

And then we also
work very closely with all of the health
information exchange groups in the state, to the Regional
Extension Center is really the point of the spear,
working with the practitioners in transforming their practice, and then reaching out to that
practitioner's network to help them exchange data,
building on the infrastructure around health information
exchange that is very briskly being
adopted in the state. With the start of hurricane
season, we have, particularly for
medical special needs patients, it's really important
that they be able to, if they have to leave
their home, that their information
is transferred to the next practitioner,
in terms of caring for them. If they do what's called
"sheltering in place," we want to make sure that
the information is available so that, as we need to support
them in their home after the storm
or after the thing has passed, that we could actually help them
and make sure that they had the services and things
that they need. During Katrina,
there in Houston, we had about 1/4 million folks
that came over from Louisiana, and they came over, and they all
needed health care.

And what we learned
during that period of time is that the key thing that was most useful
was the e-prescribing. We were able to quickly work
with the state agencies and other groups to get access
to that medication data, and that was really important
to be able to understand what the patients'
medications were, because that gives the doctors
taking care of the patients some clues, in terms of at least
being in the right ballpark, in terms of what their problems
and things like that are. All of this -- implementing
electronic health records -- is difficult, because you're
really changing the practitioner's work flow. But the Regional Extension
Centers, what we've been funded to do
is to help that practice understand what their work flow
is, implement the technology that's going to support
their work flow and minimize the impact on their
practice revenue and the amount of time
and the cost that is associated with implementing
electronic records.

The goal is to basically really
try to use this as an opportunity for getting
physicians back in a leadership
role for their patients, in terms of quality. The patients really need
to start asking questions, and in fact, it's really
funny -- our practice gets calls regularly now
from patients that are seeking a doctor,
and one of the first questions they ask is, "Do you have
an electronic health record?" And I think that's great. The second thing that I think
patients need to ask is, "Do I have access
to my information?" Through what's called
a patient portal. EHRs alone will not assure
quality of care.

Use of the data from EHRs,
and bringing that back into a quality improvement
program for the practitioners, that's what will actually change
how care is delivered. Integrating EHRs into a local
health information exchange to make sure that
this doctor's data is exchanged with
the other doctor's data to keep everyone
on the same page is how we're actually going to
be able to do several things that are going to be
very important for reducing the costs and
improving the care of patients. In terms of being able
to decrease duplication of services, not repeating the same MRI --
you go to this doctor, and they say,
"Well, I need to do this, because I don't have
access to it." Another big thing is in terms of
medication reconciliation. This doctor often doesn't know
what's been prescribed, and you can't just rely
on the patient memory or the bag of medications
that they show up with in the office.

We really need to be able
to use the existing data that's out there in exchanges to be able to focus
on those two key things. The thing to start
thinking about is, just like you discharge
a patient, we need to think of discharging
the patient's information to the patient's medical record back to their primary care
doctor. So it's a big believer
in people, processes, and then using technology
to support effective processes..