Health informatics is changing the way North Carolinians receive their care. Informatics systems such as the personal electronic health record (Epic@UNC) – and devices like smartphones and FitBits – have great potential to bring patients and providers together. This outreach of practice into community will place individuals at the center of their own care and improve the way providers treat individual patients. These systems will also make cutting-edge research available to more North Carolinians in rural and other areas that have never had such opportunities.
Sam Cykert and Tim Carey have been working to bring newer and more personalized informatics systems to North Carolina. They believe that approaching health care through informatics will better the lives of North Carolinians, lead to a more efficient health-care system, and produce better patient outcomes.
Improve communication among health providers and patients
Many patients need more than one health-care provider, and all patients have multiple professionals on their care team: doctors, nurses, pharmacists, care assistants, therapists, etc. In order to adequately care for patients, we need to communicate not just within an office or a hospital, but across multiple facilities. As UNC providers adopt our new electronic health record (EHR), Epic@UNC, our ability to communicate among offices and hospitals in Chapel Hill, Raleigh and across the state is rapidly increasing. Equally important, patients can more easily and securely access information, such as lab tests, from their own health record, and communicate with their providers. North Carolina’s new Health Information Exchange will allow providers throughout the state to rapidly receive discharge summaries of hospitalizations and other information when patients have an important health event. If a patient has had a CT or other test at another hospital, we need to be able to obtain the results of those tests in order to treat the patient appropriately when they come to a UNC Emergency Department. Health Information Exchange will allow us to do just that.
Improve quality of care
Computers don’t improve the quality of health care delivered in a clinic or a hospital. Doctors, nurses, pharmacists and your care team do that. But…good information systems and the analyses based on them can go a long way to assisting health-care providers in improving quality of care. Chronic disease accounts for 90 percent of health-care costs and the lion’s share of individual suffering and morbidity. Clinical informatics systems allow providers and health systems to find patients who have significant health problems but have had difficulty maintaining their care for a variety of reasons. This function gives providers the information that they need to reengage people and provide the necessary education and support systems to get serious health problems under control. For instance, the EHR can be programmed to create a list of diabetics with poor glycemic control who have not attended appointments in the last four months. By generating this list, the practice can then reengage these patients and intensify their care to prevent downstream complications. Also, information gathered as part of routine care can be used to identify patients who might need screening tests or other preventive procedures, sending them and their doctors reminders that it’s time for their mammogram or a needed immunization.
Make clinical research more accessible to more patients
In the United States, clinical research is often conducted with a relatively small number of patients affected by a given disease. Providers need to find out whether the test or treatment works before offering it to all patients. Despite the fact that many patients want to participate in clinical research, getting information to patients and their doctors regarding an opportunity to participate in a study has been difficult. EHRs, through digital diagnostic codes, are able to identify patients affected by particular health problems who might respond to a new treatment or service. By allowing a larger, more diverse group of patients to participate in a study, if they wish, we will quickly and efficiently know what helps people in real-world settings and what helps those who are historically less represented in research studies.
Currently, evaluating a new test or medication may take well over a decade. By using informatics, we hope to decrease both the time needed to adequately evaluate treatments and the cost of conducting such studies.
Computers don’t lose information
This is an issue we now take for granted, but prior to the widespread use of electronic medical records doctors everywhere would commonly walk into an examination room with no knowledge of care the patient had received in the past. Up to 10 percent of visits were conducted in this way. The paper chart may have been en route somewhere in the hospital, in another doctor’s office, or in a storage facility. An extreme example is all the medical records lost during Hurricane Katrina. Practicing medicine with limited information is inefficient since tests may be unnecessarily repeated, and can be dangerous if the doctor doesn’t have access to information such as past surgeries or prior side effects from medications. Using an EHR creates a history that cannot be lost.
Place the patient at the center of their own care
Too often, our health-care system has seemed designed for the convenience of doctors and hospitals, not patients. Everyone would like to place our patients at the center of their own care so they can help their providers prioritize tests and treatments and make the best decisions for their own health. Access to information through health-care informatics is one component of patient-centered care. Informatics tools under development will accelerate this process. These tools could be as simple as a reminder system in the EHR to prompt needed care at a single visit or as complex as a massive data search tool to identify individuals or communities that need a unique health risk urgently addressed so that patients can be informed of important health issues on a timely basis. For example, years ago a medication for digestive problems was found to cause fatal heart arrhythmias and there was no effective, systematic way to inform patients about this risk. By combining clinical and pharmacy data, a modern informatics system could rapidly identify patients taking the dangerous drug and contact each affected individual to discontinue the medication, preventing numerous life-threatening events.
Health care providers have barely scratched the surface of how to engage patients in their health away from the office setting. With novel mobile health devices such as smartphones and FitBits we can find ways to monitor serious illnesses at home, remind patients what they can do to optimize their care, and motivate people in enjoyable ways to prevent illness through good health habits or to manage chronic illness before the effects get out of hand. The result is truly individualized care.
Sam Cykert, MD, is professor of medicine at UNC in the Division of General Internal Medicine and Clinical Epidemiology and Director of the UNC School of Medicine Program on Health and Clinical Informatics. He also serves as the clinical director of the North Carolina Regional Extension Center for Health Information Technology and NC AHEC Practice Support Services as well as Chair of the Practice Support Committee for the North Carolina Healthcare Quality Alliance. These roles have involved leadership of a program that has involved over 1100 primary care practices with 4000 providers. The program, part of the North Carolina Area Health Education Centers Program (AHEC), provides practice-based consultation to assist providers reach “meaningful use” of electronic health records then perform rapid cycle quality improvement for important chronic care measures. His research activities emphasize access to care, resolution of health disparities, and primary care practice improvement.
Tim Carey, MD, MPH, is professor of medicine and director of the Cecil B. Sheps Center for Health Services Research at UNC. His clinical appointment is in the Division of General Medicine. He also serves as Associate PI of the NC TraCS Institute, UNC’s CTSA affiliate. His research focuses on evidence-based medicine, access to care, health disparities, medical outcomes, and technology assessment. He has been involved with UNC’s electronic health record initiatives from the first phases of WebCIS through our recent Epic launch.