Dominique Alessi
According to the National Institute on Aging, life expectancy has progressively increased since World War II, by up to 30 years in some regions of the world.1 As the elderly population expands, so too does the severity and variety of illnesses. This illuminates the necessity for the rising generation to address these issues and to improve the quality of life of the elderly population.
The electronic health record (EHR) system may be the key. EHRs provide a means to store, organize, and analyze medical records on the computer. Though a relatively new innovation, it has great potential to enhance preventative care, primarily through making patient information easily accessible and large-scale data analyses more efficient. While there are numerous benefits to this new system, there has been reluctance among doctors to embrace it, particularly because of the loss of patient-doctor interaction. If medical professionals can find a way to utilize the EHR system in their practices and minimize its negative effects, we may be well on our way to preserving the health of the elderly population.
A well-designed EHR system may be extremely beneficial for a medical practice, enabling doctors to streamline data without having to gather, sort, and analyze stacks of papers. Doctors can examine a patient’s progress over several years and refresh their knowledge of the patient’s issues, forgoing repetitive conversations of the patient’s medical status. This is critical when it comes to elderly patients, who often have many years’ worth of health records.
Dr. Donald Barr, Associate Professor of Sociology and Human Biology at Stanford University, states that EHR systems can also provide medical practitioners with a “health care trajectory.” Doctors can look at patterns of care within various groups and in relation to these groups ask, “how are we doing?” Doctors can also assess patients with conditions such as heart disease or obesity in order to determine if they are completing the proper tests and treatments. A consolidated source of information can allow physicians and public health officials to address weaker areas in the health care system, improve quality of care, prevent and reduce health problems, and thereby decrease the incidence of hospitalization of patients, including the elderly. This latter consequence may even extend into the economic sphere where according to Barr, “you only need to keep a person out of the hospital one time to save thousands of dollars.”
The applicability of EHR systems extends to medical research, as well. Nigam Shah, a researcher at the Stanford Center for Biomedical Informatics Research, uses EHRs to study the safety of different drugs. According to Shah, only about 20% of medical issues are examined using solid evidence from clinical trials due to limited resources. By using EHRs, researchers can productively and efficiently analyze patterns, such as the impact of diet on the prevention of cardiovascular disease. The EHR system, therefore, acts as a stimulus for medical research, which in turn increases doctors’ knowledge of how to prevent and treat illnesses. Improving treatment and preventative care will unequivocally lead to increases in quality of life of the elderly.
Despite the numerous benefits that EHRs have to offer, just a fraction of doctors’ offices have implemented the system. According to Barr, one main problem with the EHR system is that physician-patient interactions can be compromised. Using the paper-based record system, doctors face their patients and converse directly with them during appointments. Using the EHR system, however, doctors typically face their computer, only intermittently offering eye contact. Some patients may not be bothered by this change, but others may experience negative reactions. For elderly patients in particular, Barr notes that “this bond is critical to the patient following through with their medications and other assigned tasks.” Implementing an EHR system in this case could potentially undermine the health of the elderly population. In fact, it could even exacerbate the illnesses and anxiety associated with loneliness and lack of social interaction, both of which would be amplified by a decline in the patient-physician relationship.
The recent development of “patient-centered medical homes” may provide a way to minimize the aforementioned effect. According to the Agency for Healthcare Research and Quality, five main goals of this rising development: comprehensive care, patient-centered treatment, coordinated care, accessible services, and quality and safety.2 In order to achieve these goals, the patient-centered medical home requires a “team of care providers” to meet the needs of patients. The team develops an understanding of the patient’s “unique needs, culture, values, and preferences” in order to determine and modify appropriate treatment, ease of transitions between types of care, readily offer accessible services, and provide frequent updates to improve the system and ensure patient satisfaction.
The HER system makes the implementation of these goals feasible. EHRs provide a common base from which the team of professionals can collaborate; electronic records offer a means to observe and analyze demographic trends, making data easily transferrable from site to site. Patient information is more readily available to both patients and the providers of services with whom patients communicate. These records can also provide the data necessary to reflect on the success of the patient-centered medical home program.
Though expensive, medical experts seem confident in the program’s ability to address problems with the health care system and improve preventative medicine. Dr. Lars Osterberg, the Chief of General Internal Medicine at the VA Palo Alto Health Care System, has embraced the patient-centered medical home in his own practice, and believes it has “transformed the way of handling patients.” Some doctors, particularly older ones not as well-versed in technology as their younger colleagues, hesitate to adopt change and seek to maintain the one-on-one relationship between doctor and patient. But Osterberg touts the importance of a “multidisciplinary, team-approach” in implementing thorough and appropriate medical care. Additionally, the reduction in hospitalizations can justify the upfront implementation costs. Ultimately, in embracing this system, health of the elderly can be cultivated to a greater extent.
Dr. Donald Barr works as an Associate Professor of Sociology and Human Biology at Stanford University. He has conducted research in the Soviet Union to examine the structure and quality of their health care system. He currently focuses on the impact of demographic differences on pre-medicine students.
Nigam Shah serves as an Assistant Professor of Medicine at Stanford University. He received his MBBS from Baroda Medical College in India, a Ph.D. from Penn State University, then came to Stanford to finish his postdoctoral work. Much of his current research involves the use of EHRs to analyze trends in medicine.
Lars Osterberg is the Chief of General Internal Medicine at VA Palo Alto Health Care System and a Stanford Healthy Policy Associate. He attended UC Berkeley, earning a degree in bioengineering, received his MD from UC Davis, and earned his Master’s in Public Health from UC Berkeley. He came to Stanford to finish his residency and now works as a Clinical Associate Professor of Medicine at Stanford School of Medicine. His current research focuses on patient adherence to medication and on the accessibility of health care.
References
1. National Institute on Aging. Research on global health and aging. Available at: http://www.nia.nih.gov/research/publication/global-health-and-aging/living-longer. Accessed on February 24, 2013.
2. Agency for Healthcare Research and Quality. Defining the PCMH (Patient Centered Medical Home). Available at: http://pcmh.ahrq.gov/portal/server.pt/community/pcmh__
home/1483/PCMH_Defining%20the%20PCMH_v2. Accessed on February 27, 2013.