Tom Sullivan, M.D.

Reflections of a Rocky Road

If you are a physician or clinician involved with patient care in America today, you have been thinking and reading about – or perhaps even using – Electronic Health Records (EHR). In fact, if you are even remotely connected to the healthcare delivery system, e.g. as a very occasional patient or perhaps a rare caregiver, you have been hearing about the issue whether you like it or not.

In addition, administrative office managers, billing clerks and hundreds of other stakeholders who traditionally did not interact with personal health information, aka Protected Health Information – PHI – are becoming more engaged since the advent of the privacy and security components of HIPAA and more recently the HITECH act.

Within a few short years, the socioeconomic impact of EHRs has had a pervasive and profound influence on healthcare that will grow and continue for many years to come. As a practicing physician with more than 35 years of direct patient care, I have been an unrelenting champion of this trend for at least the past 25 years, despite the considerable pitfalls and many twists and turns that have led to disappointments, mistakes and failures along the journey.

I have some well formed opinions and lessons learned to share, but I also recognize I still have much to learn from this complex and ever changing environment that is shaping the future of one of the most sacred endeavors in human history – relieving pain and suffering, caring for the sick and infirm and promoting wellness as much as possible.

The recent rapid acceleration of clinical Information technology – significantly different than the innovations in diagnostic and therapeutic technology – has allowed us to collect, organize and share vital information much more readily and efficiently than was thought possible only 5-10 years ago.

In its essence it’s all about COMMUNICATION…“Anywhere, anytime on any device”…To quote one of the early visionaries of the digital age.

A well designed, robust and sophisticated EHR has well over a hundred functions, but in my opinion the ability to capture essential information from multiple sources, organize and store the data and share it securely, easily and rapidly with those who have “ a need to know”…far outweighs all the other functions combined.

Finally, the ability to incorporate “clinical decision support” at the point of care has grown from just “icing on the cake” a few years ago, to the “sine qua non” for “meaningful use” that marries quality improvement to cost reduction. Its best and clearest manifestation is two way Electronic Prescribing (between prescriber and pharmacist/PBM), coupled with a continuously updated and innovative knowledge base to help with Drug- Allergy, Drug-Drug, Drug -Formulary and other interactions such as Drug- Diagnosis, Drug- Lab, and soon Drug- Genome.

The eRx function represents the most rapid ROI, and easiest module to implement in terms of prospective changes to clinical workflow for most physicians, though this varies considerably by specialty.

Since this is a blog and by definition brief, I have touched just superficially on some of my ideas and long experience with clinical information technology, EHRs and eRx and their impact on my practice and my staff. More to follow over the next few weeks.