A Healthier Future Through Technology
UT System Institutions Use Electronic Medical Records to Improve Patient Care and Safety
Visualize yourself in the hospital with a family member who has suddenly become violently ill. The hospital staff asks you an endless series of questions. You try to recall the medication your loved one is taking, her doctors’ names, what she is allergic to and all the other vital information that could significantly impact her care. But, your memory is no substitute for her detailed medical records sitting in some doctor’s file room.
Thankfully, all six University of Texas System health institutions are taking advantage of advances in technology and the Internet to implement health information technology (HIT) systems that will help solve these and other issues. While at various stages of implementation, all are striving to store a patient's medical information electronically, in the form of an electronic medical record (EMR), and to make it easily available online to the patient and those who can improve their care, including doctors, nurses, staff and authorized family members. EMRs capture and document the interactions with a particular health care provider and can include lab results, reports, doctors’ notes, allergy information, medication and other data. Many have the ability to connect with other systems, such as imaging facilities, specialists, labs and other doctors’ offices so that test results and reports can be shared in real-time, assuring that all parties responsible for addressing a particular health issue have accurate and up-to-date information. The quality of care for you and your loved ones will be vastly improved. "The investment our institutions are putting into health information technology makes me optimistic about the future of health in Texas," says UT System Executive Vice Chancellor for Health Affairs Kenneth I. Shine. “Every day, we are seeing that our efforts in this area are enhancing the quality of care and experience we provide our patients.
Patients No Longer Need to Be So Patient
The University of Texas M. D. Anderson Cancer Center's program, myMDAnderson, began in 2003 with the goal of improving the patient experience. As Alan Powell, Director of Internet Services at UT MD Anderson, puts it, "In the beginning, the primary driver was to improve customer support and service. Patients said that medical care at MD Anderson was great. But, once pressed, some said, 'Well, now that you mention it, it's hard to get through on the phone’ and others mentioned having trouble modifying appointments. So, it was more about the practical and logistical needs of our patients versus medical needs. One of the benefits to patients is the convenience. It’s easy."
In just a few keystrokes, many HIT systems are now allowing patients to make or change appointments, refill their prescriptions, pay bills and communicate with their doctors, nurses and office staff. Using their computers, patients are avoiding multiple phone calls and wait times. Doctors and health care providers can send prescriptions to the pharmacy electronically, alleviating mistakes due to poor handwriting or the misreading of abbreviations by the pharmacist. With EMRs, patients can refill their own prescriptions and access an archived history of prescribed medications. Any forms can be completed online and most redundancies can be avoided. The days of having to fill out form after form with the same information at each doctor’s visit will soon be behind us. Put simply, it should help all of us avoid a lot of unneeded frustration at an already stressful time in our lives, when we or family members are receiving medical care.
Building a Network of Care
At The University of Texas Southwestern Medical Center at Dallas and UT MD Anderson Cancer Center, the patient’s entire medical file is now easily accessible, in a strictly confidential record. The same information, such as lab results, medical reports, radiology reports, pathology reports and allergic reaction/drug interaction information, is provided to authorized doctors, referring doctors, community doctors and patients. Kirk Kirksey, Vice President for Information Resources at UT Southwestern, points out EMRs are providing the fastest, most accurate and most efficient way to communicate HIPAA-compliant information between patients, physicians and the care team. At UT MD Anderson, pathology and lab reports are held from patients for seven days to allow time for doctors to analyze, review and talk to the patient first. If lab results are abnormal or alarming, doctors won’t post them on the website without speaking to the patient first. Whether a UT Southwestern patient visits an outpatient clinic or its university hospital emergency room, physicians have immediate access to the patient’s detailed medical information. With all health care providers having accurate and timely information, quality of care is improved and medical errors are decreased.
Much more secure than e-mail, these systems enable patients to privately send questions to or share concerns with their doctors and nurses. Unlike the telephone, the involved parties don’t have to be available at the same time. And, the "conversation" is saved, archived and viewable to everyone in the patient’s care network, leading to more informed decision-making on their behalf.
Online communication can also be valuable for those patients who have difficulty communicating over the telephone. Alan Powell of UT MD Anderson provides the example of patients who have head and neck cancer who have had their larynx removed. As they learn to speak again in a new way, they now have the ability to communicate without relying on the telephone.
Granting access to trusted family members and caregivers strengthens the network of care for patients and empowers them to take control of their health care. UT Southwestern's Kirk Kirksey relayed his experience using an EMR system when his father had congestive heart failure, "My mother would keep his medicines handwritten in a spiral notebook. With his electronic medical records, we could look up his history and see what he needed to take online. We could then take him to any hospital with that information. It also helped improve his quality of life. He could refill his prescriptions online and avoid being on the phone on hold for a long time. For caregivers it's great. Users have the right to share their records with others. And, it's a web-based tool, so it can be accessed from anywhere." With everyone in a patient's health care support system sharing the same, accurate information, EMRs lower the chances of medical errors and improve the quality of care.
While much of the focus is rightly on the needs of a patient when he or she is in the hospital or in the middle of a medical crisis, Lynn Vogel, Vice President and Chief Information Officer at UT MD Anderson, explained the importance of preparing for future care. MD Anderson compiles electronic documentation, called survivor passports, for patients to use in follow-up appointments with community physicians. Having up-to-date, accurate records organized and easily accessible can be critical in the case of future emergencies.
Health information technology is also changing the in-person patient/physician experience and the way information is communicated in the room. Now, doctors can easily bring up a patient’s record and swing the computer screen around to share reports and images with the patient.
Physicians no longer have to be in the same physical location to compare notes or analyze the same images. Looking at separate computer monitors, hundreds or thousands of miles away from one another, they can be looking at exactly the same thing, discussing it on the phone or exchanging web-based messages. Patients travel from all over the globe, not just Texas, to benefit from the top-notch medical care provided at UT System health institutions. When patients return home, EMRs are a wonderful way to ensure local doctors are on the same page with UT doctors.
"This is really the transition from a 'my patient' view to an 'our patient' view and that's a big change. Doctors can now consult with one another online. Where it was a patient to physician relationship, it's now a one-to-many relationship," says Andrew Krecek, Senior Director of Information Technology Services at The University of Texas Health Science Center at San Antonio.
Ralph Farr, Vice President of Information Services and Chief Information Officer at The University of Texas Medical Branch at Galveston was fortunate enough to experience this himself. "My physician brought up my record and another doctor I was seeing in a clinic about 10 miles away was seeing it at the same time. Each doctor had access to the other’s notes. They amended an order, made some additional changes and cross-checked other items right on the spot. It gave me a feeling of confidence to see that two health providers I was seeing for different reasons knew what the other was up to."
Health care providers can also use EMRs to share educational materials with patients. Information can be patient-specific and supplemented with an online library of related documents, FAQs and videos. With some systems, hospital staff can add suggested events, such as classes, and patients can add their own personal notes.
Improving the Quality of Care and Patient Safety
The collection and analysis of data encourages continuous improvement in patient care through the use of HIT systems. Tracking aggregated patient data and outcomes helps identify opportunities for quality improvement. And, these improvements lead to high patient satisfaction and stronger trust between patients and their physicians. UT Medical Branch - Galveston's Ralph Farr says, "What's exciting is how we can mine the data to find out what is helpful. We can share results and collaborate on what's working." Andrew Krecek, from UT Health Science Center San Antonio, points out that this new technology makes keeping patients healthy proactive versus reactive. Complications can be predicted and prevented before they occur. And, Kirk Kirksey at UT Southwestern says, "The point where research and clinical trials merge has so much potential. Electronic medical records give us the data to analyze outcomes. Analytics is the new frontier that EMRs are spawning."
It also helps individual doctors monitor their own level of care. Dr. Mysti Schott, MD, a doctor and professor specializing in internal medicine at UT Health Science Center San Antonio says "I can go into the system to see if I'm meeting the standards for quality. For example, with the click of a few buttons, I can analyze the quality of care being provided to diabetic patients. I can see how it compares to national standards, to other UT institutions and to the practice as a whole."
At The University of Texas Health Science Center at Tyler, Chief Information Officer John Yoder reports that by the end of the calendar year, the institution should have an EMR system implemented for its ambulatory clinics. He says, "There are lots of ways it'll improve patient safety. The data will be electronic and real-time, so it will enable things like real-time allergy checks and drug verifications. It will prompt physicians when tests need to done."
Such built-in warning systems alert doctors to drug allergies and potentially harmful drug interactions and remind them to perform certain tests or procedures. Some EMR systems automatically analyze patient data to predict and potentially prevent complications. And, the digitization of forms and data collection is also helping to reduce errors resulting from poor legibility of some handwritten medical records.
Because physicians now have access to the right data at the right time, the risk of medical errors is significantly reduced. EMRs are changing the way doctors work. Ralph Farr from UTMB sees EMRs as an evolution and points out "This is a new, more immediate way for doctors to work. They will be able to monitor intensive care patients from home."
Dr. Mysti Schott from UT Health Science Center San Antonio says, "It has helped me greatly in innumerable ways. It helps facilitate communication with my clinical staff. No matter where I am, I can review records, put in instructions, view x-rays and send messages. It also helps on the weekend when I'm on call. At home, I can view an electronic record to see what a patient's allergies are or other medical problems. It also prompts us when tests are needed for a patient. And, if they are one of my colleague's patients, I can get on the computer to see what the colleague's plans are."
Moving to a Single View
Currently, UT health institutions are placing high emphasis on interoperability, the ability for EMRs from different health care facilities to easily work together. Ideally, this will create a comprehensive, electronic health record for each patient called a Personal Health Record (PHR). PHRs would contain data from many sources, including EMRs, and would be a complete and accurate medical history for an individual across all health facilities visited. PHRs already exist, but, currently, the burden of keeping them up-to-date, complete and accurate falls to the individual.
"Getting all of these systems to interact is a challenge. As an institution with many disciplines and as part of the Texas Medical Center, the largest medical center in the world, we are uniquely positioned to help solve this issue. We're working on it now with other Texas Medical Center institutions. We all use systems that are a little bit different. It's very important that we figure out how to share electronic medical records," says Rick Miller of The University of Texas Health Science Center at Houston (UTHealth-Houston). "Once this is done, patients will be able to go to different facilities and won't have to start the process from the beginning each time. For example, a patient could be rushed to Memorial Hermann's trauma center and her electronic medical record could be there waiting for her even if she had never been there before."
Jerry York, Vice President and Chief Information Officer at UT Health Science Center San Antonio adds, "We must focus on health information exchange and making many, many systems talk to each other with the end goal of a single physician interface,"
A Healthier Future
At the UT health institutions, health information technology is firmly in place and the benefits are already being realized. In April 2010, UTHealth-Houston received two grants, totaling $30.3 million to bolster health information technology efforts. The grants were funded by the American Recovery and Reinvestment Act of 2009. Passed by Congress on February 13, 2009, and signed into law four days later by President Obama, the act provides funding incentives to health care providers to adopt and use health information technology in a meaningful way.
As continued technology advances combine with the built-in model of continuous learning and improvement EMRs provide, patients across Texas and the world will benefit from the foundation being laid today at UT System institutions.