Using Health Information Technology for Optimal Patient Care and Service

Chapter 9 Using Health Information Technology for Optimal Patient Care and Service



Bruce Bagley, Steven Waldren



Chapter contents


Components of Patient Care 120
Care of the Individual 120

Care of a Population 121

Care Management Support 121

Managing Patient Relationships 121

Monitoring and Improving Quality and Performance 121

Decision Support 122

Office Business and Management Functions 122

Integrating and Connecting Systems and Functions 122
Workflow Management 122

Organizing Information for Point-of-Care Decision Making 122

Health Information Exchange 123

Professional Development 123

Conclusion 123


Key Points


• Information technology must support the core office functions for finances, personnel, and clinical quality.

• Information management is essential for quality patient care and efficient practice operations.

• Well-organized clinical information at the point of care means better decisions for patients.

• Registries are required for a population approach to complete and timely care.

• Information technology must help the team with care management and care coordination tasks.

• Computers can enhance patient and care team relationships through communication, education, and self-management support.

• Quality measures and reporting capability must be embedded in the EHR.

• Decision support tools ensure patient safety and timely, evidence-based care.

We live in a world that is so rich with information that managing, filtering, and organizing the data has become our most important challenge as we strive to use information technology (IT) to help us deliver reliable, high-quality care to our patients.


In the past the goal for family physicians was to have the electronic health record (EHR) selected, implemented, and working efficiently. Unfortunately, many EHR systems focused primarily on recording the office visit and support for billing and coding decisions. Over time, systems evolved to provide better support for office workflow, electronic prescribing, and clinical information management. Real-time interoperability and widespread health data exchange remain challenges for clinical practice and for the U.S. health care system.


Information technology and the installation of hardware and software in the practice should not be a goal in and of itself. Computers must be configured and connected to support the key management functions of the medical office for finances, personnel, and clinical quality. For this reason, we organize this chapter by considering each of the core functionalities required for efficient medical office functioning. We describe how health information technology should be used to greatest advantage and address the need for integration, connectivity, and data exchange.



Components of Patient Care



Care of the Individual


Individual patient care will continue to be at the heart of what we do as family physicians. Documenting, organizing and transmitting the record of patient care over time must be well done, efficient, and communicated clearly to others. Electronic health records should help physicians document an accurate and complete account of the patient’s care, including history, physical findings, laboratory tests, imaging results, advice from other specialists, medications, preventive measures, and screening efforts. A problem and medication list helps to present this information in a tabular form for easy reference and summarizes most of the important information that should accompany the patient wherever he or she receives care. The personal health record should capture the majority of this information so that all providers have access, as needed.


Most EHR systems rely on templates to enter information in discrete, searchable fields. There is always tension between the need for providing sufficient detail (granular data) and the burden of entering too much detail without additional benefit to patients or physicians. At times, free text may be necessary to communicate precisely what is happening, such as a complex symptom history. Other information, such as routine physical findings, treatment plans, medications, and tests are more useful if entered in a tabular format (granular data) so that they can be identified and used to generate orders, check for allergies or interactions, feed decision support tools, and generate documents for transmission to others.


Personal health records for individuals are critical to ensure that important information about the patients’ medical problems, current treatments, usual sources of care, and medications go with them whenever they need evaluation or treatment. Electronic health records should be able to interact with the personal health record to keep it accurate and up-to-date. In essence, the personal health record is a “snapshot” of the EHR at a point in time. It should be updated whenever there are any changes. The Continuity of Care Record (CCR) standard provides a format for the collection and transmission of this important data.



Care of a Population


In addition to caring for individuals, the office care team has the responsibility to monitor and manage their ability to care for the population they serve. This may apply to a particular condition (e.g., diabetes) or preventive services (e.g., immunizations, recommended screenings). Although the care each individual receives is important, the aggregate of the care that all patients with a particular condition receive is a better indication of the effectiveness of the overall approach to care.


Registries are used to track and organize information about all patients with a particular condition. For example, a registry for diabetes would include all patients in the practice who have been identified as diabetic. It should provide the office team with information about the patient’s most recent visit (e.g., glycosylated hemoglobin and lipid levels, blood pressure results), eye exam date, and patient self-management goals. Many registries provide information for proactive contact with patients whose clinical parameters are missing or out of range. Registries provide the opportunity for patient care and contact between visits, in addition to highlighting needed services during the visit.


Ideally, EHRs should be able to integrate the registry function into the workflow and draw data from appropriate sources automatically. If this function is not integrated into the EHR, stand-alone and web-based products are available to help manage a population of patients.

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Oct 3, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Using Health Information Technology for Optimal Patient Care and Service

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