Electronic health record functionality needed to better support primary care

Krist, Alexander; Beasley, John W.; Crosson, Jesse C.; Kibbe, David C.; Klinkman, Michael S.; Lehmann, Christoph U.; Fox, Chester H.; Mitchell, Jason M.; Mold, James W.; Pace, Wilson D.; Peterson, Kevin; Phillips, Robert L.; Rm, Post; Puro, Jon; Raddock, Michael; Simkus, Ray; Waldren, Steven E.

doi:10.1136/amiajnl-2013-002229

Cited by 104 publications

(67 citation statements)

References 27 publications

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“…EHRs may provide a foundation for improving the delivery of primary care by enabling the collection, measurement, and reporting of patient outcomes and quality of care. [34][35][36] The ABP itself has recognized the critical role of health information systems in facilitating QI activities as part of MOC. 37 When e7…”

Section: Discussionmentioning

confidence: 99%

Improving HPV Vaccination Rates Using Maintenance-of-Certification Requirements

Fiks

Luan

Mayne³

2016

Pediatrics

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BACKGROUND: Many pediatricians are now required to participate in American Board of Pediatrics Maintenance of Certification (MOC) Part IV programs focused on improving health care quality, but the benefits of participation are unproven. METHODS: Twenty-seven primary care pediatricians from 11 primary care practices participated in a 1-year MOC program for human papillomavirus (HPV) vaccine. Participants received education and electronic health record (EHR)-generated performance feedback reports with their rates of captured HPV immunization opportunities (dose given at eligible visit) and those of peers. In each of 3 cycles, clinicians collectively identified a goal for improvement. Rates of captured opportunities among adolescents 11 to <18 years old were tabulated, and statistical process control charts were created to evaluate changes over time among participants compared with 200 nonparticipants. Provider perceptions of the program and time invested were recorded via survey. RESULTS: Participating clinicians missed fewer opportunities for HPV vaccination than nonparticipants. MOC participants significantly increased their captured opportunities relative to nonparticipating clinicians by 5.7 percentage points for HPV dose 1 at preventive visits and by 0.7 and 5.6 percentage points for doses 1 and 2, respectively, at acute visits. There were no significant differences for other doses. The estimated program cost was $662/participant. Of the participating pediatricians, 96% felt the effort to participate was warranted, and half would not have joined the project without the MOC requirement. CONCLUSIONS: Participation in MOC Part IV improved vaccination at modest cost and with high pediatrician satisfaction, demonstrating benefits of the program that may help to inform future initiatives.

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Section: Discussionmentioning

confidence: 99%

Improving HPV Vaccination Rates Using Maintenance-of-Certification Requirements

Fiks

Luan

Mayne³

2016

Pediatrics

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“…16,17 In response to concerns like these, a recently published primary care consensus statement concluded that many EHR systems need marked refinement to promote greater patient engagement. 18 One proposed solution to improve patient engagement and the flow of information while using EHRs during the clinical encounter is the use of medical scribes. While the roles of scribes can vary based on the nuances of a given clinical setting, in general scribes are personnel specifically hired to chart patient-clinician encounters in real time, from the beginning of the encounter to its end.…”

mentioning

confidence: 99%

The Use of Medical Scribes in Health Care Settings: A Systematic Review and Future Directions

Shultz

Holmstrom

2015

The Journal of the American Board of Family Medicine

120

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Background: Electronic health records (EHRs) hold promise to improve productivity, quality, and outcomes; however, using EHRs can be cumbersome, disruptive to workflow, and off-putting to patients and clinicians. One proposed solution to this problem is the use of medical scribes. The purpose of this systematic review is to summarize the literature investigating the effect of medical scribes on health care productivity, quality, and outcomes. Implications for future research are discussed.Methods: A keyword search of the Cochrane Library, OvidSP Medline database, and Embase database from January 2000 through September 2014 was performed using the terms scribe or scribes in the title or abstract. To ensure no potentially eligible articles were missed, a second search was done using Google Scholar. English-language, peer-reviewed studies assessing the effect of medical scribes on health care productivity, quality, and outcomes were retained. Identified studies were assessed and the findings reported.Results: Five studies were identified. Three studies assessed scribe use in an emergency department, 1 in a cardiology clinic, and 1 in a urology clinic. Two of 3 studies reported scribes had no effect on patient satisfaction; 2 of 2 reported improved clinician satisfaction; 2 of 3 reported an increase in the number of patients; 2 of 2 reported an increase in the number of relative value units per hour; 1 of 1 reported increased revenue; 3 of 4 reported improved time-related efficiencies; and 1 of 1 reported improved patient-clinician interactions.Conclusions: Available evidence suggests medical scribes may improve clinician satisfaction, productivity, time-related efficiencies, revenue, and patient-clinician interactions. Because the number of studies is small, and because each study suffered important limitations, confidence in the reliability of the evidence is significantly constrained. Given the nascent state of the science, methodologically rigorous and sufficiently powered studies are greatly needed. (J Am Board Fam Med 2015;28:371-381.)

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“…Personal doctors must take action to ensure that health IT enhances rather than diminishes relationships and patient care. We can participate in the development of new EHR functionality that better supports personal doctoring and relationships, 16 insisting that this functionality be prioritized over the billing and transactional features that have dominated EHR design. Personal doctors can help to enable technology and data to inform our collaborations with patients, families, and communities.…”

Section: Strengthening Relationships Through Technologymentioning

confidence: 99%

The Personal Doctoring Manifesto: A Perspective from the Keystone IV Conference

DeVoe

Barnes

Morris

et al. 2016

The Journal of the American Board of Family Medicine

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The Keystone IV Conference was a touchstone moment for multigenerational conversations regarding our health care system and an opportunity to reconnect with the values of personal doctoring as a vocation. It inspired participants to renew commitments to relationships, healthy communities, and social change. Keystone IV was also a stark reminder of the need to rekindle family medicine's counterculture flame in today's tumultuous health care environment and reclaim the role of personal doctors in American society. Reimagining and reigniting the fire of personal relationship is today's counterculture movement for primary care. Personal doctors must heed the call for immediate action, which requires defining when relationships matter most in health care and understanding how to harness paradigm shifts in information technology, team-based care, and population health to strengthen, rather than undermine, personal doctoring. Simultaneously, we must also invent a new notion of personal doctoring that creates partnerships with patients and families to drive forward a social movement demanding health care focused on the whole person in the context of his or her community. Change will occur when patients insist on a personal doctoring approach as an essential priority for what they expect from the health care system-that anything less is unacceptable. (J Am Board Fam Med 2016;29:S64 -S68.)Guest editors' note: This article was prepared after the G. Gayle Stephens Keystone IV Conference by attendees who were compelled by their participation in the conference to formulate recommendations for action to enable personal physicians to make and honor their commitments to patients and their communities. It constitutes a Keystone IV "call to arms" from a multigenerational set of authors. In a famous article that described family medicine as counterculture, Gayle Stephens 1 recognized how family medicine was able to take advantage of the social movements of the 1960s to affirm a model of the personal doctor grounded in strong relationships with patients. He described how family medicine, itself a counterculture, aligned with reforms This article was externally peer reviewed.

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Electronic health record functionality needed to better support primary care

Cited by 104 publications

References 27 publications

Improving HPV Vaccination Rates Using Maintenance-of-Certification Requirements

Improving HPV Vaccination Rates Using Maintenance-of-Certification Requirements

The Use of Medical Scribes in Health Care Settings: A Systematic Review and Future Directions

The Personal Doctoring Manifesto: A Perspective from the Keystone IV Conference

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