EHRs Mean Better Information, Better Decisions, and Better Care, Says Internist

From 2005 to 2007, Dr. Larry Garber, an internist and Medical Director of Informatics at Reliant Medical Group in Worcester, Massachusetts, led an upgrade of Reliant’s electronic health record (EHR) system. The undertaking was ambitious. Reliant Medical Group is a large multi-specialty organization with more than 330 providers serving approximately 200,000 patients in central Massachusetts. Once Reliant Medical Group got the new EHR system up and running, Dr. Garber and his colleagues began using their EHR to improve health care quality for their patients with diabetes.

The Challenges of Caring for Patients with Diabetes

Dr. Garber and his colleagues at Reliant knew there were several challenges to managing health care for patients with diabetes. Many of their patients were not “in good control” of their diabetes, according to Dr. Garber. Many patients, for example, were frequently missing important appointments and failing to schedule preventive screenings. Dr. Garber and his colleagues recognized inadequate diabetes control could mean suboptimal outcomes and increased health care costs for their patients, so they decided to adopt “a collaborative, comprehensive approach to managing the care of patients with diabetes.”

A Multi-Step, Collaborative Approach

To help improve health care quality and patient outcomes for its patients with diabetes, Reliant Medical Group is using clinical decision support (CDS) to foster a collaborative, multidisciplinary approach to improving care. Reliant uses a multi-step quality improvement process, which is supported by CDS, when a patient with diabetes is not up-to-date on preventive screenings – such as blood sugar testing or eye examinations.

• Step 1 –Appointment Scheduling: The EHR system will alert Reliant’s front office staff if the patient scheduling an appointment has not obtained recommended preventive screenings so the front office staff can remind the patient to obtain the screenings before the appointment.
• Step 2 – Pre-Visit: If the patient has not obtained the screenings a week before the appointment, one of Reliant’s nurses will call the patient to again remind the patient to get the screenings.
• Step 3 – In the Exam Room: If the patient still has not completed screening by the time of the visit, the patient’s physician receives an automated alert to remind the patient.
• Step 4 – Post-Visit: Following the patient visit, the EHR automatically generates a reminder letter for patients who are still deficient.

If patients still have not obtained recommended screenings after all the reminders, Reliant’s EHR system automatically adds the patient to an electronic registry that tracks “actionable deficiencies” – such as missed preventive screenings – for patients with diabetes. Health coaches then call patients with high numbers of actionable deficiencies to help the patients improve their overall health management.

Improved Patient Outcomes

Reliant’s team-based, collaborative approach has led to significant improvements in diabetes care. The medical group’s HbA1C screening rate increased from 94% to 97%, and the approach is also improving patient outcomes. After rolling out the diabetes program, the percentage of Reliant’s patients with diabetes with good control of their condition increased from 88% to 94%. “We take all these steps as part of a comprehensive approach designed to improve health outcomes and prevent adverse events for our patients with diabetes,” explained Dr. Garber.

Take It from One Who Knows

Reliant Health Group is working with the Massachusetts eHealth Institute – one of 62 Federally-designated Regional Extension Centers —to assist other medical practices interested in making the switch to an EHR system and improving health care quality. The medical group also participates in the Centers for Medicare & Medicaid Services (CMS) Pioneer ACO Model and several of its primary care practices have received National Committee for Quality Assurance Level III recognition status as Patient-Centered Medical Homes.