EDITORIAL

The Electronic Health Record: Is It Meaningful Yet?

Endoscopists are performing greater numbers of procedures, often on patients with complex conditions, in ambulatory settings because of changing patient demographics and referral patterns. To assist with the pre-procedure assessment of such patients, we deployed an advanced electronic health record tool, the Queriable Patient Inference Dossier (QPID), to review clinical histories and generate e-mail alerts to providers, based on clinical guidelines.

Study the feasibility of an automated pre-procedure alert system for outpatient endoscopy.

We retrospectively reviewed 5 physicians' use of the application and their responses to the alerts.

A hospital-based endoscopy unit and its two satellite outpatient clinics, Boston area, Massachusetts.

Adult outpatients referred for endoscopy with moderate sedation.

Pre-procedure alerts automatically sent 7 days before the procedure, highlighting any conditions/clinical history that may affect management of the patient.

Physician use of the pre-procedure alert system and its effect on patient management.

We studied 1682 procedures that met inclusion criteria for review by QPID and 364 alerts (1.6% of the eligible procedures). Nearly 80% of the alerts were reviewed and responded to by the physicians, and 70 total alerts resulted in a change in patient management (4.2% of eligible procedures).

The small size of the study group and the low rate of adverse events during the study period limit our findings. We thus plan to conduct a larger follow-up study to demonstrate changes in safety and efficiency.

Use of advanced electronic health record technologies, such as QPID, may improve provider efficiency and patient outcomes in endoscopy units.

The recent confluence of: (1) changing state and national insurance-related policies, and (2) the rapid growth in electronic health record (EHR) use, yields an unprecedented opportunity for patient-centered medical homes (PCMHs) and other primary care practices or care settings to use health information technology (HIT) and health information exchange (HIE) in novel ways to impact patient health. We propose that HIT is an untapped resource for supporting clinic-based efforts to help eligible patients obtain and maintain insurance coverage. This commentary presents a conceptual model and guiding principles for this idea. Additionally, it describes insurance support tools that could be used to conduct ‘inreach’ and ‘outreach’ with patients around health insurance, similar to how HIT is used to manage chronic disease and panels of patients, and to improve population health outcomes.