Thursday, January 05, 2012

Electronic Health Records Are Making A Difference - Again!

The following press release hit my desk a few days ago.

Blue Cross & Blue Shield of Rhode Island Electronic Health Record Program Delivers Better Health, Lower Costs

Three-year pilot laid the groundwork for patient-centered medical homes by providing physicians with the tools necessary to provide more integrated and higher quality care
(Providence, RI, 12.12.2011) -  Blue Cross & Blue Shield of Rhode Island (BCBSRI) today announced results from a multi-year pilot program designed to increase the use of electronic health records (EHRs), transform the way healthcare is delivered, improve members’ health and help moderate healthcare costs.  Results of the pilot, which ultimately became the foundation of BCBSRI’s patient-centered medical home model, demonstrate clear value in using health information technology to improve quality of care.  Highlights of the pilot include the following:
  • Lower monthly healthcare costs that averaged between 17 and 33 percent less per member than those receiving care at non-participating practices
  • Improved healthcare quality, with a 44 percent median rate of improvement in family and children’s health, 35 percent in women’s care and 24 percent in internal medicine
  • Successful EHR implementations for 79 local physicians
"A recently published New England Journal of Medicine study showed that EHRs improve quality of care for patients with diabetes by reducing unnecessary testing, helping to prevent adverse events and improving patient care coordination as compared to practices that use paper-based methods," said Dr. Gus Manocchia, senior vice president and chief medical officer at BCBSRI.  "We have believed for some time that using EHRs makes it easier for us to help members manage chronic conditions.  Unfortunately, a lot of local practices just don't have the resources to implement these types of record systems, which is what prompted us to establish the pilot program.  We are grateful that so many local primary care physicians agreed to partner with us in this effort to improve the quality of care received by their patients."
Dr. Pablo Rodriguez, Board Chairman of the Health Care Alliance and CEO of Women’s Care, Inc. agrees:  "Every provider believes that they deliver excellent care, but it wasn’t until we looked at the EHR data that we realized the reality of our profession wasn’t meeting the expectation.  You can’t improve what you don’t measure, and while paper is very forgiving, software never forgets.  Implementing an EHR brought the entire practice to a level of collective responsibility for the care of our patients that until this time was implied, but never measured.  We are grateful for this incredible opportunity to work with BCBSRI to improve patient care in remarkable ways."
If a provider without an EHR wanted to understand if patients with diabetes were getting the right tests, for example, he or she would need to pull possibly dozens of paper patient files, search for test results and then manually compile and analyze those results.  With an EHR, by contrast, the provider is able to quickly run a report on all patients with diabetes and easily identify which ones may require follow-up to ensure that they are getting the necessary testing.  With the average primary care physician treating more than 2,000 patients a year, it’s easy to see how an EHR can provide doctors with greater insight into their patients’ needs and significantly increase doctors’ ability to improve quality of care.
As part of the BCBSRI pilot, 79 primary care physicians (Internal Medicine, Ob/Gyn, Pediatrics and Family Practice) received partial funding for the purchase of an EHR and monthly stipends in the first and second years of the program to compensate for time spent on EHR implementation and workflow redesign activities.  Participating physicians also had the opportunity to receive performance bonus dollars based on improved preventive care and outcomes for 10 quality measures established by BCBSRI in conjunction with participating primary care physicians.  In addition, one group of 11 local physicians also received funding for an onsite, office-based case manager to assist in actively coordinating care for patients in those practices.
“What’s really exciting is that these pilot results are a good predictor of the types of improvement in healthcare quality and cost that we expect to see once our patient-centered medical homes are more established,” concluded Manocchia.  “BCBSRI looks forward to continuing to collaborate with the local primary care community on innovative ways to improve both the affordability and quality of care.”
According to Manocchia, more than 25 percent of the state’s primary care physicians currently practice in a patient-centered medical home, providing improved healthcare services—supported by their EHR systems and onsite nurse case managers—to approximately 100,000 BCBSRI members.
For additional details regarding this program, please visit
Blue Cross & Blue Shield of Rhode Island is the state’s leading health insurer and covers more than 600,000 members.  The company is an independent licensee of the Blue Cross and Blue Shield Association.  For more information, visit and follow us on Twitter @BCBSRI.
The original release is found here:
The NEJM article mentioned is found here:
Now Rhode Island is only a tiny State in the US - population just over 1 million - so it is the ideal spot to be able to try out idea where a changed care model and more Health IT are deployed to try and improve things.
On the basis of this work one is really forced to conclude they are doing something right!
It is important to note that the health insurers were providing a lot of transitional cost support to providers - knowing it was in their long term interests. Pity about DoHA in this regard!
As a late note some of the figures supporting the initial release have been withdrawn, but the broadly positive impact was re-confirmed.

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