The difference we see in a modern clinical information system today compared to 20 years ago is due to the advancement of system design knowledge and innovation in information technology (IT). The quality of these systems is enhanced by connectivity, electronic integration, and knowledge management.
Some areas of an ambulatory practice have not changed. The physical layout of an office is strikingly similar to that of a practice 50 years ago. The exam room, scheduling system, and office visits remain the same as it was then. The difference comes with the development of new clinical knowledge, diagnostic and treatment technologies, and pharmaceuticals.
Consider the following components of a modern physician practice:
- EMR, electronic medical records i.e.: Medisoft Clinical
- Practice management system, Medisoft PM
- Customized encounter forms
- Disease registries
- Secure messaging and connectivity (email and patient portal)
- Access to clinical information
- Practice decision support
- Patient decision support
- Electronic diagnostic technology
- Network faxing
- Interfaces with laboratory, radiology and hospital systems
- Inter office email
- Telecommunications system
These components reside on a network that includes an operating system, high speed Internet access, voice recognition software, secure remote access, backup systems, and antispam/antiviral software. Some other applications are word processing, spreadsheet, general ledger and accounting software. This system must connect and integrate information from within and outside the practice.
To show how these components relate to a patient, we will use Barry as our sample patient.
Barry is a healthy 44 year old male who has in the past had high blood pressure from his exam in January 2012. He was seen as a new patient for hypertension management. Past medical history shows blood pressure of 165/100 and possible mid-systolic click followed by a murmur suggesting mitral value prolapse.
Barry had a routine cardiac risk assessment based on the National Cholesterol Education Program guidelines using a tool built into the EMR (electronic Medical Record). The diagnosis of hypertension along with his age moved Barry into a moderate risk category for coronary artery disease. The patient had not had his cholesterol level checked in several years and the category showed his LDL cholesterol target was less than 130 mg/dl.
The patient was started on generic lisinopril, an effective antihypertensive and was encouraged to purchase an automated blood pressure monitor. Instructions for Barry including targets for systolic and diastolic blood pressure were given to try and achieve the goals. Fasting lipids were ordered and echocardiogram to evaluate his heart.
Barry was contacted by both phone and email for a follow up. Automated reminders were placed in the EMR as prompts to review his blood pressure management. Secure email would be used to provide feedback of test results or to answer questions and provide coaching about hypertension self-management.
The lipid panel was performed by a local lab and the reading was sent directly back to the EMR in an electronic format. Those results were made available to Barry the next day with an explanation. Barry’s LDL was below his target, so no specific treatment was necessary.
The echocardiogram was done by a local cardiology group and the reading was sent to the primary practice the following day. This was then forwarded to Barry through secure email as they continued hypertension management with each exchange documented in the EMR.
This case demonstrates the evolution of ambulatory care. The needs of this patient were not extraordinary, but it is easy to see how technology-enabled care can be applied. A patient with chronic conditions will have much more contact with the practice using the connectivity and electronic systems.
Iron Comet Consulting is a certified Platinum Reseller for McKesson and is located in Stockbridge Georgia. We are a full service medical IT and billing company.