Friday, November 11, 2011
It Seems The PCEHR is Down The List For Managing Chronic Illness. There Are Better Things To Do!
I spotted this article a few days ago.
November 01, 2011 | Michelle McNickle, Web Content Producer
When it comes to costly care, those with chronic diseases tend to take the cake. But, in recent years, studies have shown IT can help manage these diseases, all while cutting down costs and improving quality.
We asked Fred Pennic, senior advisor with Aspen Advisors and author of the blog Healthcare IT Consultant, to show us some of the ways IT is currently helping manage chronic diseases:
1. Patient monitoring tools/medical devices. According to Pennic, medical devices that offer patient monitoring tools help patients manage their own chronic diseases, such as diabetes, weight management and more. “As time progresses, more medical devices will be created to combat the demand of self-monitoring tools, which will allow patients the freedom to manage their chronic diseases,” he added. Not to mention, studies have proven patient-friendly devices positively impact patient acceptance, dosage compliance and health outcomes. In fact, patients are willing to pay more for ease of use, and they’re making informed decisions when it comes to tools and devices already on the market.
2. Mobile applications. Mobile apps have become a mainstay not just for professionals, but also for patients. They're "important tools that allow patients to simplify their disease management,” said Pennic. “With mobile apps and widgets, patients can access a variety of information within an arm’s reach.” Pennic added that mobile apps such as My Asthma Tracker, GI Monitor, various blood pressure trackers and OnTrack Diabetes provide a myriad of tools to help patients monitor their disease on their smartphone.
3. Clinical decision support systems.
4. Health information exchanges/patient portals.
The comments around item 4 are very interesting.
“Pennic said health information exchanges provide professionals with the interoperability of sharing health information across multiple organizations. “And this provides patients with more efficient care, which improves the management of chronic diseases,” he said. “This doesn’t only reduce the redundancy of patient care, but also gives healthcare providers better capabilities to manage chronic diseases.” In addition, health information exchanges can help avoid any gaps in history when a patient visits another organization.”
Again we hear the message that what matters is optimising information flows between providers - which is clearly just not the focus of the PCEHR. Most especially in the chronic disease situation it is vital to make sure there is reliable and trustworthy communication between all the different care providers to ensure we minimise the issues of having people ‘fall between the cracks’!
Additionally, it is the chronic care situation where consent for information exchange is the easiest to come by as the sicker patients are the ones who what to make sure no-one does the wrong thing with their care in an information vacuum. Once we have it working then is the time to develop patient access tools to the information held by their primary care provider - not the other way around.
On that topic I note there is some work underway to refine the already over-engineered shared care summary that is meant to be a core element of the PCEHR.
As I looked at these draft plans which are being consulted upon (to a restricted audience as usual because of the haste all this is being done) - and the lack of any authenticated individual log on to access the PCEHR - I realised that the risk of taking information held in the PCEHR system seriously is rather high. This is because if you act on what you read - and it later changes - there won’t be any easy way to know medico-legally just how the system looked at the time of your particular access. The implication of this is that the state of the system as the time of each access needs to be part of any audit trail - which can’t be live and robust without full implementation of NASH.
If the clinician has to check each fact found in the PCEHR with the patient the utility of using the system drops rather dramatically.
Those designing the shared care record would be well advised to keep the shared summary very, very basic to start with!
I do wish this program was being much better managed and planned than seems to be the case.
Posted by Dr David More MB PhD FACHI at Friday, November 11, 2011