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Electronic Health Records: Design, Implementation, and Policy for Higher-Value Primary Care

2014; American College of Physicians; Volume: 160; Issue: 10 Linguagem: Inglês

10.7326/m13-2589

1539-3704

Christine A. Sinsky, John W. Beasley, Greg E. Simmons, Richard J. Baron,

Health Policy Implementation Science

Ideas and Opinions20 May 2014Electronic Health Records: Design, Implementation, and Policy for Higher-Value Primary CareChristine A. Sinsky, MD, John W. Beasley, MD, Greg E. Simmons, MA, and Richard J. Baron, MDChristine A. Sinsky, MDFrom Medical Associates Clinic and Health Plans, Dubuque, Iowa; University of Wisconsin School of Medicine and Public Health and MetaStar, Madison, Wisconsin; and American Board of Internal Medicine and ABIM Foundation, Philadelphia, Pennsylvania., John W. Beasley, MDFrom Medical Associates Clinic and Health Plans, Dubuque, Iowa; University of Wisconsin School of Medicine and Public Health and MetaStar, Madison, Wisconsin; and American Board of Internal Medicine and ABIM Foundation, Philadelphia, Pennsylvania., Greg E. Simmons, MAFrom Medical Associates Clinic and Health Plans, Dubuque, Iowa; University of Wisconsin School of Medicine and Public Health and MetaStar, Madison, Wisconsin; and American Board of Internal Medicine and ABIM Foundation, Philadelphia, Pennsylvania., and Richard J. Baron, MDFrom Medical Associates Clinic and Health Plans, Dubuque, Iowa; University of Wisconsin School of Medicine and Public Health and MetaStar, Madison, Wisconsin; and American Board of Internal Medicine and ABIM Foundation, Philadelphia, Pennsylvania.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M13-2589 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Electronic health records (EHRs), and the policies and workflows around them, are inconsistently aligned with the needs of primary care patients and physicians. This results in substantial waste of physician and support resources, high rates of burnout (1, 2), and a decrease in primary care capacity precisely at the time when our nation needs a stronger primary care foundation (3).We propose a set of principles (Table) directed toward vendors, institutional leaders, policymakers, and physicians to support higher-value primary care. These principles draw on our expertise in patient care, quality assurance, industrial and systems engineering, and policy and EHR implementation. ...References1. Babbott S, Manwell LB, Brown R, Montague E, Williams E, Schwartz M, et al. Electronic medical records and physician stress in primary care: results from the MEMO Study. J Am Med Inform Assoc. 2014;21:e100-6. [PMID: 24005796] CrossrefMedlineGoogle Scholar2. Friedberg MW, Chen PG, Van Busum KR, Aunon FM, Pham C, Caloyeras JP, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems and health policy. Santa Monica, CA: RAND; 2013. Accessed at www.rand.org/content/dam/rand/pubs/research_reports/RR400/RR439/RAND_RR439.pdf on 4 April 2014. Google Scholar3. Shipman SA, Sinsky CA. Expanding primary care capacity by reducing waste and improving the efficiency of care. Health Aff (Millwood). 2013;32:1990-7. [PMID: 24191091] CrossrefMedlineGoogle Scholar4. Stetson PD, Bakken S, Wrenn JO, Siegler EL. Assessing electronic note quality using the Physician Documentation Quality Instrument (PDQI-9). Appl Clin Inform. 2012;3:164-174. [PMID: 22577483] CrossrefMedlineGoogle Scholar5. Linzer M, Manwell LB, Williams ES, Bobula JA, Brown RL, Varkey AB, et al; MEMO (Minimizing Error, Maximizing Outcome) Investigators. Working conditions in primary care: physician reactions and care quality. Ann Intern Med. 2009;151:28-36. [PMID: 19581644] LinkGoogle Scholar6. Toll E. A piece of my mind. The cost of technology. JAMA. 2012;307:2497-8. [PMID: 22797449] CrossrefMedlineGoogle Scholar7. Beasley JW, Wetterneck TB, Temte J, Lapin JA, Smith P, Rivera-Rodriguez AJ, et al. Information chaos in primary care: implications for physician performance and patient safety. J Am Board Fam Med. 2011;24:745-51. [PMID: 22086819] CrossrefMedlineGoogle Scholar8. Hess DR, Tokarczyk A, O'Malley M, Gavaghan S, Sullivan J, Schmidt U. The value of adding a verbal report to written handoffs on early readmission following prolonged respiratory failure. Chest. 2010;138:1475-9. [PMID: 21138883] CrossrefMedlineGoogle Scholar9. ABIM Foundation; ACP-ASIM Foundation; European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136:243-6. [PMID: 11827500] LinkGoogle Scholar10. Beasley JW, Holden RJ, Sullivan F. Electronic health records: research into design and implementation [Editorial]. Br J Gen Pract. 2011;61:604-5. [PMID: 22152827] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Christine A. Sinsky, MD; John W. Beasley, MD; Greg E. Simmons, MA; Richard J. Baron, MDAffiliations: From Medical Associates Clinic and Health Plans, Dubuque, Iowa; University of Wisconsin School of Medicine and Public Health and MetaStar, Madison, Wisconsin; and American Board of Internal Medicine and ABIM Foundation, Philadelphia, Pennsylvania.Disclaimer: Drs. Sinsky and Beasley and Mr. Simmons are members of the National Collaborative for Improving Primary Care Through Industrial and Systems Engineering (I-PrACTISE), but their views do not represent any formal policy statement from I-PrACTISE. Dr. Baron is CEO at the American Board of Internal Medicine (ABIM), but the views expressed here are not those of the ABIM.Disclosures: None. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2589.Corresponding Author: Christine A. Sinsky, MD, Medical Associates Clinic and Health Plans, Department of Internal Medicine, 1000 Langworthy Street, Dubuque, IA 52002; e-mail, [email protected]com.Current Author Addresses: Dr. Sinsky: Medical Associates Clinic and Health Plans, Department of Internal Medicine, 1000 Langworthy Street, Dubuque, IA 52001.Dr. Beasley: University of Wisconsin School of Medicine and Public Health, Departments of Family Medicine and Industrial and Systems Engineering, 1100 Delaplaine Court, Madison, WI 53715.Mr. Simmons: MetaStar, 2909 Landmark Place, Madison, WI 53713.Dr. Baron: American Board of Internal Medicine and ABIM Foundation, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106.Author Contributions: Conception and design: C.A. Sinsky, J.W. Beasley, G.E. Simmons.Analysis and interpretation of the data: J.W. Beasley.Drafting of the article: C.A. Sinsky, J.W. Beasley, G.E. Simmons, R.J. Baron.Critical revision of the article for important intellectual content: C.A. Sinsky, J.W. Beasley, G.E. Simmons.Final approval of the article: C.A. Sinsky, J.W. Beasley, G.E. Simmons.Administrative, technical, or logistic support: J.W. Beasley, G.E. Simmons.Collection and assembly of data: J.W. Beasley. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoElectronic Health Records Michael E. Miller Electronic Health Records Alan W. Feld Electronic Health Records John W. Beasley and Christine A. Sinsky Electronic Health Records John W. Beasley and Christine A. Sinsky Electronic Health Records Alan W. Feld Electronic Health Records Michael E. 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Miller, MDElectronic Health RecordsAlan W. Feld, MD 20 May 2014Volume 160, Issue 10Page: 727-728KeywordsDecision makingDisclosureElectronic medical recordsHealth careHealth care providersHealth care quality assessmentHealth information technologyPatientsPrevention, policy, and public healthSafety ePublished: 20 May 2014 Issue Published: 20 May 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...