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In What Seems Like An Effort To Make Nice, eClinicalWorks Joins OpenNotes Initiative

Posted on October 12, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

eClinicalWorks has decided to try something new. The health IT vendor has announced that it will support the OpenNotes project, an initiative in which doctors share their notes with patients.

As most readers will know, it recently came to light that eClinicalWorks had gotten itself into some very hot water with the feds. eCW was forced to pay a $155 million settlement when the U.S. Department of Justice concluded that it had faked compliance with EMR certification standards.

Now, perhaps in an effort to make nice, eCW is making it possible for its customers to share visit notes using its patient portal. Actually, to be precise, the patient portal already had the ability to offer visit summaries to patients, but OpenNotes capabilities enhance these summaries with additional information.

OpenNotes, for its part, got its start in 2010, when Beth Israel Deaconess Medical Center, Geisinger Health System and Seattle’s Harborview Medical Center decided to study the effects of letting patients read their medical notes via a portal.

The study, the results of which were published in the Annals of Internal Medicine in 2012, concluded that patients approved of note-sharing wholeheartedly, felt more in control of their care and had an easier time with medication adherence. Also, while some doctors reported changing documentation during this process, the study also found that doctors saw no significant changes in workload.

Perhaps most telling, at the end of the process 99% of patients wanted OpenNotes to continue, and none of the participating doctors opted out. A movement had been launched.

Since then, a long list of organizations has come on board to drive implementation of open notes, including Kaiser Permanente Northwest, Providence Health System, Salem Health and Oregon Health and Science University. This year, OpenNotes announced that 16 million Americans now had access to their medical notes online.

Back in 2012, I asked readers whether OpenNotes would eventually influence EMR design. Today, I would suggest that the answer is both “yes” and “no.”

On the one hand, I have little doubt that the project helped to advance the notion that patients should have on-demand access to their healthcare information, and moreover, to use it in managing their care. While some doubted this approach would work, OpenNotes can now be said to have sold the idea that health data transparency is a good idea. While the initiative had its doubters at its outset, today patient record access is far better accepted.

On the other hand, eClinicalWorks is the first EMR vendor I’m aware of to explicitly announce its support for OpenNotes. While it’s hard to tell what this means, my guess is that its competitors don’t see a need to take a position on the matter. While vendors are certainly being forced to take patient-facing data access into account, we clearly have a long way to go.

EMR Quality Data May Not Be Very Accurate

Posted on January 18, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new study suggests that the quality data residing in EMRs may or may not reflect the actual state of the patient population. The study, which appears in the Annals of Internal Medicine, concludes that the accuracy of EMR-based quality measures can be questionable, sometimes overestimating and sometimes underestimating the delivery of quality care.

The study, done by Weill Cornell Medical College, analyzed clinical data from EMRs run by one of the largest community health center networks in New York state, reports Healthcare IT News.  Researchers from Weill Cornell looked at the accuracy of EMR reporting for 12 quality measures (11 of which are Meaningful Use standards).

After comparing their analysis with a manual check, researchers found that in three areas, reports drawn from EMRs weren’t as accurate as they should be. They underestimated the percentage of patients getting prescriptions for asthma and those getting vaccinations to protect against bacterial pneumonia. Another problem measure predicted that more patients with diabetes had healthy cholesterol levels than actually did.

What’s causing the gap in accuracy? For one thing, doctors and nurses entering data in EMRs may be entering data in fields that aren’t being captured by quality reporting algorithms, HIN’s piece suggests.

While the story doesn’t say this, I think there’s also some gaps in quality reporting generally which have existed since well before EMRs became commonplace.  I don’t know how to address the issue — other than perhaps appoint a nurse-manager to track the progress of quality reporting and ride herd on their colleagues — but given how important quality reporting is, it seems that it will be necessary to devote more resources to the problem.