Technology Backbone for an Evidence-Based Practice

Friday, April 16th, 2010
This post was written by Melanie Matthews

Registry or electronic health record? Dr. Richard Baron, president and CMO of Greenhouse Internists, defines the roles and limitations of these technologies in the delivery of evidence-based care.

There are four areas of activity to adopt evidence-based principles in a practice: technology, staff, patients and doctors. When it comes to technology, I am a big fan of electronic health records (EHRs). Although it’s not my favorite way to do things, there are organizations doing some of this work using freestanding registries, which are databases that a doctor or a practice might log into and enter data, then use the registries to manipulate those data and generate performance reporting or automated patient outreach.

Many people view registries as a bridge technology. They say EHRs are a big deal for doctors to do and a registry is easier, and that if they could just do registries, then they can do that even in a paper office. That’s true, but the problem with a registry is it tends to be disease-specific. It requires “double entry bookkeeping” — everything that you write in the chart also has to be put into the registry.

It’s better for doctors to move to an EHR model, because then when you write a prescription, it’s already in the registry. When you process the lab report, it’s already in the registry. Everything goes into the database all at once. But that’s a very complicated process to manage in a practice.

To move toward an evidence-based practice, look for aspects of EHR support such as embedded decision support. For example, the EHR knows whether it’s a man or a woman and it knows the age of the patient, so it can make recommendations about preventive care that should be done for somebody in that age group. Of course, that’s more powerful when it’s linked to knowledge of what’s already been done. It’s great to say that the patient is a woman between the ages of 50 and 65 and she needs a mammogram, but it’s even better if the EHR knows whether she’s had a mammogram and can turn off that alert when she doesn’t have it and use it as a reminder of when she does.

You need to use the EHR “intentionally.” Most doctors adopting EHRs today are adopting them for the word processing feature of information technology (IT). They’re more interested in the generation of a progress note.

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