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April 6, 2013 2:54 pm

We are an NCQA Level 3 PCMH. We are part of a pilot that requires reporting on 18 adult CQMs. MU and PQRS also require CQM reporting. CQMs need to be unified and automated by EHR companies. Our EHR company is now trying to charge for data extraction on CQMs that should be automated. This poses added obstacles to the movement from data extraction to analysis to practice change.

We also find that some CQMs are CPT-based and can’t be generated by PCP offices. The insurance cos should use claims data to generate them and report back to PCPs. Example: mammogram and colonoscopy. We can use our registries to identify the actual patients in need of testing.

Finally, a KLAS rep informed me that EHR companies foresee statewide HIEs becoming obsolete. That would be the opposite of… more »

…what PCPs and our patients need. I hope ONC will use its clout to push back against privatization of HIE, especially as that has a large price tag and works against care coordination across regions where patients have freedom of choice, like Baltimore.

Thanks!!! « less

April 6, 2013 3:03 pm

I love sharing information with my patients. Since starting with EMR in 2006, I give every patient a copy of his/her note at the end of every visit. Most patients love it, and the ER doctors and specialists love it as well. I was called a revolutionary by a respected colleague two years ago but am glad to see research published on the benefits of information sharing with our patients. It is key to patient engagement for them to own not only their information but their health. Patients should be empowered. In the end, though, they still need the guidance of excellent PCPs who stand at the ready to guide them.

April 8, 2013 8:39 am

1. Existing Patient Portals: Let’s give patients access to their information. First, we need challenge doctors and other healthcare providers to accept the wisdom of information-sharing with patients (perhaps giving mental health an exception, due to sensitive information). Then, challenge the vendors to expand patients’ access to their charts through existing secure Patient Portals (eCW has an excellent one). Also challenge them to provide a mechanism where a patient can upload information to their chart which, upon review and categorizing by PCP or primary care office, would find a place on the shared electronic medical record.

2. HIE access for patients: I favor single secure login wherever possible. I believe patient portals have to have banking-level security already,… more »

…so perhaps make a way for a patient to see his/her health information that is on HIE from within the Patient Portal of his/her respected PCP. 1st, this increases the market value of providers using EHR. 2nd, it accounts for security concerns. 3rd, it allows patients to see what is on the HIE. How HIE would be available to patients strictly on their own information? Not sure how to solve this. Fingerprint/live doppler/heat-sensitive access? Banking-level security with government-sponsored Patient Portal? The latter idea gets away from single sign-in, though.

The government should support patient-empowerment movements like PCMH. « less

April 10, 2013 8:37 am

I think the government could challenge to providers, hospital centers, etc to see the wisdom of transparency and information sharing with patients. Research shows that patients experience higher quality care when they have access to their information. I also believe it contributes to patient safety and lowers cost by avoiding redundant tests (for example, the patient knows when the last colonoscopy was). Models like the PCMH will likely push for more information sharing with patients through Patient Portals. It would be good for the government to set standards for Patient Portals so that the vendors develop features that improve patient care.

The more useful information and the more features (like secure messaging and self-scheduling appts) will improve patient adoption of Patient… more »

…Portals. Over 50% of our recent patients have signed up. They love it, and so do we.

As far as HIE, I am not sure how you could design it so that a patient could access/view what information is shared on a platform; however, I believe this might settle the anxiety of people who are concerned about privacy.

In Maryland, we have also talked about whether MOLST/POLST forms could be posted through HIE so that end-of-life orders are available across the care transitions. I think it would be a nice addition to also allow patients, perhaps via their PCP, to post Advance Directives to the HIE. « less

April 10, 2013 8:49 am

We are implementing the encounter notification service (ENS), which is still being tested by CRISP. Our hope is that our workflow can encompass the following strategy: use ENS to locate our patient in the healthcare system, go to the Provider Portal to access information, communicate provider-to-provider, obtain test results and discharge summaries prior to patient visit here, and see our patients within a week of discharge from the ER or a hospital.

We are hopeful that CRISP will evolve a single login, embedded within our EMR, that will allow us to access all of the useful features of the HIE they envision: ENS, Provider Portal, secure platform for in-writing provider-to-provider communication, and MOLST/POLST form access/update.

An added icing on the cake, which we believe is crucial,… more »

…is interfacing small practices TO the HIE so our key information is accessible at the point-of-care for our patients (at ERs or hospitals). I believe this will help our hospitalists and specialists to esteem the role of primary care providers more and ensure they have the whole picture. Hopefully, electronic communication won’t totally replace phone calls, especially in urgent cases or where a more involved conversation would be of benefit.

I agree with a recent comment that we are working with real patient, not an iPatient. Nothing will replace the in-person encounter. « less

April 6, 2013 9:23 pm

Hi hrdahlman. Thank you for your comment, and welcome to Planning Room. How can the government best support the uses of Patient Portals that you suggest?

April 8, 2013 9:17 pm

Thank you for your comment, hrdahlman. Can you elaborate on how you foresee statewide HIEs supporting your practice and patients in the future?

April 6, 2013 9:37 pm

Thank you for your comment, hrdahlman. It sounds like you are suggesting a need to balance information sharing with guidance. How have you been able to accommodate that balance in practice?

Do you have any suggestions for what the government can do to encourage patients to take ownership of their information and health?

April 11, 2013 9:04 am

Hi hrdahlman, thank you for your comment. You mention research which shows that patients experience higher quality care when they have access to their health information. Could you share some more detail about those studies or any links to the research? Also, it sounds like you think that setting standards for Patient Portals would improve patient care. Do you have any particular standards in mind?

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