Electronic Health Records and Prospective Health Care

Last week Don Berwick announced his resignation as Administrator of CMS. In his parting speech, Dr. Berwick listed his top 5 reasons as to why there is so much waste in the US health care system.

These five reasons were as follows:
1. The over treatment of patients
2. The failure to coordinate care
3. The administrative complexity of the health care system
4. Burdensome rules
5. Fraud

In a post on this week’s Health Care Blog, Dr. John Halamka argues that a common solution which would at least in part address each of these issues is the electronic health record. I think the point he is making is on the right path but that it would be better served taking it one step further: an electronic health record in the context of Prospective Health Care. Prospective Health Care is a coordinated approach to health care and wellness which involves personalized health risk assessment and the development of a personalized health care plan to ensure maximum patient involvement and engagement in their care. IN this model, the personalized health plan is coordinated between the patient, a health coach when appropriate, and the provider system.

By focusing on an electronic health record itself, we risk missing its necessary precursor – a strategic approach which addresses the needs of each patient by tailoring their health care plan to meet their individual needs. An electronic health record is a tool which would help implement and optimize this type of approach, but would be insufficient on its own.

In the context of each of Dr. Berwick’s five reasons for waste, Dr. Halamka suggests that electronic health records would mitigate each of these factors.

To address over treatment of patients, Dr. Halamka suggests that EHRs could automate alerts and reminders as to what his patients need. If such alerts and reminders are not tailored to the specific health and wellness needs of individual patients in the context of their personal health plan, one could see how these types of systematic alerts and reminders could potentially exacerbate over treatment rather than curb it.

In terms of coordinated care, EHRs will certainly allow multiple providers greater ease of access to a patient’s health and treatment information and provide the opportunity for improved communication between different providers working with the same patient but unless the patient in question has a personal health plan in place to drive the strategic approach to their individual care, there can be no guarantee that these different providers are working with the patient towards a common goal. If providers are not working in tandem the opportunity to reduce waste is missed.

Dr. Halamka also gives examples as to how the next three contributors to waste, complexity, rules, and fraud, could be mitigated by EHRs as well – mainly by streamlining some of the administrative complexities of the health care system by having EHRs that automate care plans, provide feedback at the point of care, and process payments based on measured outcomes. He also suggests that the data generated by ERHs would allow analysts to look for patterns of care that are outliers and thus potential indicators of fraud. For each of these instances it would still be important for EHRs to be utilized in the context of personalized health planning to ensure that patients are receiving and providers are being reimbursed for providing patients optimal care for their individual health and wellness goals.

While EHRs are an important tool to help drive appropriate treatment of patients, coordination of care, and reductions in administrative burdens and the potential for fraud to help eliminate waste, they can only do so optimally in the context of prospective health care.