March 15, 2011

Electronic Health Care: Just Doing It.

--by Julia Eddy, Bread for the City's new medical clinic operations coordinator!

Before Bread for the City started the expansion of our medical clinic, we'd already completed the implementation of an electronic medical records system. And that puts us ahead of the curve! See this article in today’s Washington Post about how few health practices are adopting electronic medical records (EMR), despite considerable financial incentives offered by the federal government and efficiencies to be gained by the technology.

Of course, we're still new to the field -- and always looking for fresh eyes and friendly advice. So we were delighted to recently receive a visit from Dr. Ted Eytan, whose research focuses on the potential for health information technology to empower healthcare providers and patients alike, especially through preventive practice in communities that suffer from great health disparities.

Ted came by Bread for the City the other week for a tour of our new facility and an opportunity to shadow our Medical Clinic Director, Dr. Randi.

Ted wrote about the visit recently on his blog, and we encourage you to read the whole post. Here's an excerpt:
It’s kind of amazing to see what modern, HIT-enabled medical care is like. There’s the community feel of the clinician office, with a laptop garden in the center, and clinicians following each other with electronic charts in hand with more knowledge and information about their patients (and more accountability for it) than ever.

Bread for the City is an early adopter of the eClinicalWorks EMR, as part of a District of Columbia program started in 2007. I think this makes these clinicians both more experienced about what an EHR can do, and more aware of what an EHR should and could do. That puts them in a very good position to recommend improvements to the system and I can tell a lot of innovative ideas will come from this practice. ...

Indeed, we’re more than two years into our work with Electronic Medical Records -- and it still feels like we’ve only just begun to really use this technology. Upon going “live” with our EMR system, we spent the first year grappling with a lot of technical challenges, including performance speed, reporting processes, software bugs, and even the way our small laptops fit physically into our doctors’ practice.

When I shared some of these challenges with Dr. Eytan, during a walking tour of our neighborhood (which he later documented in Flickr), he reassured me in a manner that every doctor knows well: “you’re normal,” he said. During any transition to Electronic Medical Records, there’s a period of challenging development as a clinic adapts to a new way of working. And indeed, now in our third year, we’ve worked through many of the bugs and snags and are starting to see some results -- with reliable software performance and reporting capabilities that we never used to have.

So we’re now starting to seriously explore the potential for this health information technology to transform our practice. For one, it enables our providers to have a total picture of our patients’ current medical history (including visitations with specialists and even trips to the hospital), which helps them deliver more appropriate care. And on a higher level, with our new ability to engage deeply with data from across our practice, we will be able spot health trends that are disproportionately affecting our clients -- and that, in turn, will help us develop the services that our clinic will offer in the future.

It’s all very exciting. But there are other serious challenges between where we are now and the true potential of this technology -- specifically, how can our patients directly benefit from the technology if they are not capable of using it themselves?

For instance, in his post Dr. Eytan references a “Patient Access Portal,” which wouldprovidepatients with online access to their medical records, appointment scheduling, and even electronic communication with doctors. That sounds great -- but we have a major amount of work to do before our client community participate in that kind of technological leap forward. And this is where our Health Resource Room and computer literacy classes come in: teaching the computer literacy skills that people need to engage with information technology. With some help from our community and friends like Dr. Eytan, we’re looking forward to a new world of possibilities.

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