Who could argue with this advice? The trouble is, it’s not always as easy as it sounds.
In practice for about thirty years, Basch is an internist at Washington Primary Care Physicians, an eight-physician practice located almost in the shadow of the Capitol Building in Washington, DC. The practice is part of MedStar Health, a not-for-profit health care system that includes nine hospitals as well as a large network of providers throughout the Washington metropolitan area.
Basch was an early adopter of electronic health records (EHR) and e-prescribing. “I believe I was the first physician in DC to have sent an electronic prescription order,” he says. He now serves asMedical Director for Ambulatory EHR and Health Information Technology Policy forMedStar Health.
Helping Physicians Fulfill Their Good Intentions
Basch believes that EHRs are an indispensible tool in helping physicians “do the right thing.”
“Let’s take an example, say, caring for a patient with diabetes,” he says. “Care for diabetics is not obscure. It is not contentious. We basically know what we’re supposed to do. But studies show that the reason most doctors don’t do it consistently is not that they disagree with the guidelines, but they just forget.”
“We get busy. We get overwhelmed. We had every intention of ordering a particular test or adjusting a medication for a patient, and they come in with another problem, and we end up forgetting to do it.”
EHRs help to address this problem, says Basch. “The EHR, by continually sifting through information and presenting it either through lists or prompts or clinical decision support, makes it much easier for both me and my patient to see what needs to be done.”
“When Are You Going To Start Letting Us See This Information Online?”
Although he’s now a facile user and strong advocate for EHRs, Basch didn’t always feel this way. “When I first started using electronic health records, I believed that having technology in the exam room would interfere with the doctor/patient relationship.”
But in his first week of using them, an unlikely patient helped to change his thinking.
“My first patient to come into the exam room was a little old lady in a wheelchair. She was probably 90 years old. Her son, who was a truck driver, brought her in. They were staring at me intently the entire time I was using the computer, and I thought, ‘Oh no, here I am introducing something new to people who are obviously offended by what I’m doing.’”
“As I began to apologize to them, after I was documenting her vital signs and blood sugars and so forth, the son spoke first.”
“He said, ‘You know, Mom and I are wondering when you are going to start letting us see this information online so that we can interact with it? We just got a new computer, and this would be something that would be helpful to us.’”
That conversation, says Basch, was an eye-opener.
What Is He Thinking?
Not only did Basch discover that his fears about computers interfering with his relationship with patients were unfounded. He also recognized that the technology actually has the power to strengthen those relationships.
“In a patient visit with a paper record, typically you sift through papers, pulling out and looking at pieces of information. If you raise your eyebrows or furrow your brow, the patient thinks, ‘Uh oh. What did he see? What is he thinking about? Is it serious?’”
In this scenario, says Basch, what the doctor is reading and thinking is generally a mystery to the patient. “And those paper records are not something we would typically show patients because the notes are usually scribbled and abbreviated and very hard to understand.”
Sharing Is Caring
Here’s how that visit is different with EHRs. “I ask the patient to look at the screen with me,” says Basch. “We look at the medication list, at the allergy list, at the problem list. I ask, ‘Is it correct? Do I have all the information right?’”
But that’s just the beginning of the collaborative work that doctor and patient can do with EHRs. “Particularly for patients with a chronic illness,” says Basch, “we’ll look at lab values or weight over time. So I might say, ‘I know you’ve been struggling with losing weight. Let’s look at this graph showing your weight and your blood sugar, or your weight and your cholesterol.’”
Patients can feel reinforced if they see progress, or newly motivated if they don’t. “There are teachable moments in every visit,” says Basch, “and patients come to trust the technology and the data it provides.”
In addition, says Basch, EHRs also promote more of a shared agenda during visits. “We still ask the patient the reason for their visit,” he says, “but we also have the capability of seeing what the patient needs in terms of preventive care or chronic care. So we might say, ‘OK, I know you’re here for a sprained ankle, but you’re also due for X, Y or Z.’ Increasingly I notice how much patients appreciate this.”
The Transformative Power of Technology
Basch truly believes that “technology has transformative potential, as long as we line things up appropriately.” And by “things,” he means technology, workflow, and payment.
“I understand the intersection between technology adoption, workflow change, and the associated alignment of payment,” he says. And he believes that more widespread adoption of health IT is a good first step.
“We have a very interesting opportunity right now, with Meaningful Use,” he says, referring to the federal government’s incentive program for hospitals and practices to establish and use health IT to improve care. “We have the opportunity to rise above mere compliance, to say ‘What can we do as doctors to leverage this transformation and do good things with it?”