Universal Electronic Health Records
For most chiropractors the concept of a universally accessible electronic health record (one that contains all of a patient’s health information readily available to all other practitioners) is an unknown commodity: some nebulous future innovation. But for those practicing in the military and Veterans Affairs health care systems, this type of system has been available for a decade. While it has many advantages, it also has some drawbacks. I expect that sometime in the next few years a national universal electronic health record (UEHR) will be available to all. However, it will come with its own set of challenges and rewards.
What are the Differences between Chiropractic Electronic Health Records (EHRs) and UEHRs?
Chiropractic EHRs are profession-specific records that are made specifically to record and collect information pertaining to chiropractic patients and chiropractic encounters. These are characterized by chiropractic-specific templates, aids, and shortcuts. Since these are profession-specific, they are designed to record and display relevant information swiftly. They are also intended to help productivity and be integrated with billing programs.
A UEHR is by definition universal. It is not profession or specialty-specific, and its chiropractic features are not necessarily as chiropractic friendly as a chiropractic specific ERH. Since the information in a UEHR is shared universally, profession-specific jargon is confusing. A neurosurgeon reading a chiropractor’s note diagnosing a cervical subluxation may wonder why the chiropractor did not place the patient in a hard cervical collar and transport. And what would the chiropractor think of a psychologist’s diagnosis of an adjustment disorder?
What is essential for a UEHR? It needs to be secure and secretive, but universally accessible by healthcare workers. It will need a dash board that allows busy practitioners to use analytical tools to quickly access the patient’s healthcare needs. Finally it needs to be both comprehensive and consolidated.
What is Beautiful about UEHRs?
Immediate real-time access to every aspect of the patient’s health history: Previous diagnoses, surgical procedures, treatments, provider notes, response to treatment, outcome measures, lab work, radiographic reports, diet, exercise programs, weight, blood pressure, etc.
UEHRs will prevent the prescription of contraindicated drugs, herbs, and nutraceuticals with adverse interactions, as well as multiple prescriptions of opiates or other controlled substances. It will make it easier to track disease, epidemics, child and spousal abuse, and over-utilizers.
Data collection: UEHRs are a great source of data collection. They can be used to collect and analyze comparative effectiveness of treatments and direct future deployment of health care resources. Drug safety tests are normally performed on a limited number of subjects over a finite time frame in a controlled trial. The enormous amount of data in a UEHR would be valuable and more accurate tool for analyzing drug safety. Randomized controlled studies would still be a part of the data collection process, but more of an initial phase of investigation, with the data from UEHRs providing a much larger real-world collection of practical information.
Why are UEHRs a Beast?
Recording patient encounters into a UEHR essentially makes the doctor a data input technician. The burden of recording information is placed on the shoulders of the provider, and while there is plenty of mouse and click features, the current versions require significant text input to provide clarity for other non-chiropractic providers.
Security is also a beast. The private medical information of our patients needs to be jealously protected, and the use of government-issued security cards that have specific passcodes and a secure internet connection requires significant infrastructure and IT personnel.
Massive databases have their own unique set of problems. Aside from the expense of maintaining and securing huge databases, there are infrastructure expenses and the threat of cyber-attacks and hacks.
What will happen to all of the proprietary EHRs that were purchased and populated over the years preceding the implementation of UEHR? I do not think that anyone can answer that question at this time. If they are not compatible, will doctors need to re-input the data into the new system?
Specialty Bias
Most other professions/specialties generate more RVUs per visit than specialties like chiropractic or optometry. Consequently, it places a greater burden of data input on the many visits a chiropractor may have in a day as compared to a specialty like neurology which would see fewer patients per day, but acquires more RVUs per patient encounter. For example, over the course of a day, the signing-in-and-out of 25-40 patients’ UEHRs and recording all of the required fields, a chiropractor is at a great disadvantage. It could take additional hours to complete these tasks each day.
Solutions
For years providers have failed to adequately communicate with each other. This has resulted in hundreds of thousands of injuries and deaths due to communication errors, drug interactions, drug allergies, and polypharmacy. As decision-makers design and implement the new universally accessible electronic health record, we need to ensure that easy to use chiropractic modules are included. As time and technology advances I am sure that the input portion of the UEHR will become less burdensome. We need to have a place at the table in developing the new national UEHR, and we have to get it right the first time. Otherwise my follow-on article will be titled the Agony and the Ecstasy.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088297/
http://www.emrandehr.com/2012/01/31/a-national-universal-health-record-uhr-database-doable-any-time-soon/