The Providence VA Medical Center - Rhode Island Medical Society

Electronic Medical Record and Quality ofPatient Care In the VAI was working at the Providence VAMedical Center emergency room when Iwas asked to see a new, confused, diabeticpatient, who was visiting her family inProvidence. The nurse informed me thather blood sugar was low. We took measuresto correct her blood sugar immediately.The patient was not clear regardingher medications. Her primary care physicianwas at a VA hospital in California.Logging into the VA Computerized PatientRecord System (CPRS), I gainedaccess to the patient’s recent outpatientoffice visit notes, and obtained the mostcurrent medication list. It became clearthat the patient was not taking her diabeticmedications as prescribed and thatshe was hypoglycemic because of overmedication.Via the electronic medicalrecord, VA physicians can ascertain notonly the patient’s latest data, but also a completemedical record going back as far asthe mid -1980s, including records of careperformed in any other Veterans HealthAdministration (VHA ) hospital or clinic.More than $ 1.2 trillion spent onhealth care each year is estimated to bewasted—about half the $2.2 trillionspent in the United States on health careeach year, according to the most recentdata from Price Waterhouse CooperHealth Research Institute. 1 Much of thewaste is a result of disorganization andlack of accurate information. This resultsin orders for unneeded tests and ineffectiveprocedures and in simple human error.Advanced health information technologycan reduce these consequencessubstantially in the following ways: 21. Improved communication2. More readily accessible knowledge3. Assistance with calculations4. Performance of checks in realtime5. Assistance with monitoring6. Decision support7. Requirement for key pieces ofinformation (dose, e.g.)Tanya Ali, MDBased on a well-specified definitionof electronic health records, only 17% ofUS physicians used either a minimallyfunctional or a comprehensive electronicrecords system in 2009. 3 Twenty fourfunctionalities have been identified as theessential components of comprehensiveelectronic records system. 4In 1995 the VA launched a major reengineeringof its health care system thatincluded better use of information technology,measurement and reporting of performance,integration of services, and realignedpayment policies. Health Informationtechnology benefited from significant investments6 and the CPRS was implementednationally throughout the VHA in 1999. 7,8In any VA hospital clinicians cannavigate the electronic medical recordsby logging into CPRS. Via a graphicaluser interface, physicians can access completepatient records from inpatient visits,subspecialty consults, primary carevisits, emergency room visits, laboratorydata, radiology reports, medication history,surgical notes and discharge summaries.All physicians’ work on any patientutilizes the same medical record andall entries are legible. This facilitates communicationamong care providers, makesthe data collection process efficient, savestime, and eliminates difficulty decipheringillegible handwriting.The Clinical Decision Support(CDS) component of CPRS providesclinical data, clinical guidelines, clinicalreminders, situation-specific advice, andmakes relevant information available inTable 1. Electronic Functionalities of ComprehensiveElectronic Records System 3Electronic FunctionalityClinical documentation• Demographic characteristics of patients• Physician’s notes• Nursing assessments• Problem lists• Medication lists• Discharge summaries• Advanced directivesTest and imaging results• Laboratory reports• Radiologic reports• Radiologic images• Diagnostic – test results• Diagnostic – test images• Consultant reportsComputerized provider-order entry• Laboratory tests• Radiologic tests• Medications• Consultation requests• Nursing ordersDecision support• Clinical guidelines• Clinical reminders• Drug-allergy alerts• Drug-drug interaction alerts• Drug-laboratory interaction alerts• Drug-dose support (renal dose guidance)8MEDICINE & HEALTH/RHODE ISLAND