As Dr. Charles Eaton sees it, electronic medical records could make a huge difference in many ways, but most of all, when put in patients’ hands.
Eaton envisions diabetics, for example, logging in to their personal health records to find expert dietary advice, keep a daily log of their blood-sugar levels, and alert their doctor of any problems with their vision or their feet – even schedule an appointment online.
People with cardiovascular disease might log in to track their blood pressure, look up the drugs they’ve been prescribed, or, in an emergency, quickly brief the ER doctors on their medical history.
A young mother could use her son’s record to track his immunizations, schedule regular checkups, and find out everything she needs to ensure that he eats well, gets enough exercise, and grows up strong and healthy – and that she, too, is in the best shape.
“We believe that really is the model of the future,” Eaton said in an interview. “If patients really took personal control of their health and did things proactively to improve their health … they’d either prevent disease or lessen the seriousness of any disease.”
Eaton and his colleagues at the Center for Primary Care and Prevention at Memorial Hospital of Rhode Island have believed in the power of electronic medical records for a long time. They began working toward a “paperless” practice 6 years ago – well before the hospital itself.
Already, the center has electronic records for its 12,000 active patients, and the doctors not only put all their notes online, they also track prescriptions and laboratory and imaging results that way, and use the system to communicate with one another and with the office staff.
Now, with a $50,000 grant from the Rhode Island Quality Institute, Eaton’s team is taking the project to the next level. Working with more than 400 diabetics, they plan to create a “patient portal” to those medical records that engages patients in all aspects of their care.
The goal is to use this small group to develop and test the concept, then extend the “PHR” system to the group’s entire practice. “We want it to be scalable,” Eaton said, adding that other medical practices could also use their work as a model.
The Quality Institute, which is working to promote adoption of electronic medical records and develop a statewide health information exchange, provided the grant precisely because it sees that potential in Eaton’s project.
In October, the institute had issued a request for proposals to use funds provided by the quasi-public R.I. Health and Education Building Corporation for an electronic medical records project that would establish “strong channels of communication” with patients and families to maximize the technology’s potential; explore products and services that help patients navigate the health care system through technology; educate health care stakeholders about their role in developing a “patient-centered” system; and gather information on the latest research and best practices in this field.
Eaton’s project fit the bill for many reasons, institute president and CEO Laura Adams said in the award announcement. Among other factors, it combines high-tech tools with face-to-face patient management; it engages patients in developing PHRs, to maximize their potential for adoption; it leverages a relationship with a major e-health vendor; and it involves a substantial investment by Memorial and its partners – more than 160 percent of the grant.
Eaton and his colleagues are also veterans in primary-care “best practices” research. Memorial Hospital is affiliated with the School of Medicine at Brown University, and Eaton and his colleagues serve on the Brown faculty and train residents at the primary care center.
Eaton, who is director of research at the center, has led several projects financed by federal, state and foundation grants to look at how “evidence-based” medicine can be applied to clinical practice through technology and new approaches to patient care.
Along with developing electronic medical records, the doctors have created Web sites to help patients manage their own health – and quit smoking, exercise more, etc. And for diabetics, they’ve developed a “self-management” model in which each patient sets personal goals, from taking their prescriptions regularly to reducing their hemoglobin A1c levels.
For the PHR project, Memorial has two key partners: the Quality Institute, which will provide expert advice throughout; and InterComponent Ware (ICW), a company that has developed patient health-record portals in Germany, Switzerland and other countries.
“If we didn’t have this partner pledging more than $2 million of resources,” Eaton said of ICW, “this wouldn’t be possible. We couldn’t do this.”
On the patient side, Memorial has a patient and family advisory panel that has been providing feedback on the practice in general and will also help with the PHRs. In addition, the 60 doctors have been telling patients about the project and asking for their e-mail addresses.
Next month, Eaton said, the doctors expect to have a prototype of a PHR to show patients and begin getting their feedback: Is it easy to use? Does it have helpful information? What is it missing that might be useful? Which features would they be likeliest to use? In what languages should the information be available?
Even as the prototype is developed and refined, Memorial and ICW are also working to integrate their systems for the next step – when the first PHRs for real-life patients are made.
At first, just five or six patients will get them, Eaton said, while the practice works out the kinks. Then, perhaps by next fall, the entire group of diabetics will get PHRs, and all the expectations will be tested in real life: Do they really use the nutritional info? Do they track their hemoglobin levels online? Are they e-mailing the doctors with their concerns?
“There are a lot of questions about how this will be used, but we’re just taking the first small steps,” Eaton said. Even among diabetics, who have a common set of needs, each user might find different aspects of the PHRs helpful. And in the long run, the portals have to be useful for the healthy and the sick, young and old, patients and caregivers alike.
“The idea is that it has to be consumer-oriented enough” to be good for all, Eaton said.
The grant is for a year, though the project may take longer than that, and to fully develop this system will cost millions of dollars, he said.
But once the technology and the components are in place, and the questions have been answered and the problems solved, going from 400 to 12,000 shouldn’t be that hard at all, Eaton said. “That will be very cheap.”