Saturday, October 11, 2008

AHRQ Web M&M on Electronic Health Records

Every month, the federal government's Agency for Healthcare Research and Quality (AHRQ) publishes a free on-line journal about patient safety or some other aspect of quality. Edited by Bob Wachter, MD, these articles take the form of a case report with discussion by an expert. (There is also a quiz and free CME for physicians and others.) This month, the spotlight article focuses on the safety impacts possible by linking together medication information and laboratory information across a variety of settings - primary care, Emergency Room, and inpatient hospital. The discussant, Ted Eytan, MD, MS, MPH, argues that an Electronic Health Record could have prevented the repeated medication errors described.

In particular, Dr. Eytan argues that routine discharge summaries are ineffective in getting the right information to the primary care provider at the right time. Although he advocates for full-scale cross-institutional EHR solutions, I feel there is plenty of room for specific focused solutions to the problems of communicating with us primary care physicians. As much as I would love to have a full-service EHR, we can't afford to wait! We need to use the solutions that are on hand now and integrate them into the EHR when it is finally ready.

As always, AHRQ's Web M&M is always well-written, thoughtful, and worth checking out.



  1. You said "I feel there is plenty of room for specific focused solutions to the problems of communicating with us primary care physicians" What are your suggestions past CC-ing notes to

  2. Simple applications like a shared problem list, or a shared medication list, are orders of magnitude easier to implement than a full service EHR and would get us a lot of the potential value of the EHR in the short run.

    Likewise, decision support based on laboratory values from all sources (a la Vermedx) would have alerted the PCP in the Web M&M case that continuing to push the hypoglycemic agents is a bad idea.

    What bothers me is that we often hold off on implementing a good narrow solution to a problem like diabetes decision support, or shared problem lists, because they don't also optimize billing, improve scheduling, and reduce the hospital's overhead. Maybe the perfect EHR will do all those things (maybe not), but it can't do them yet. Meanwhile, the perfect kills the good.

    Thanks for your comment.



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