January 2008

Grant Results

SUMMARY

In 2005–06, Gordon T. Moore, M.D., M.P.H., a professor and physician at Harvard Pilgrim Health Care, conducted a study of electronic medical records. Some political leaders and health care experts have touted this technology's potential to reform medical practice. Moore's premise was that currently available records systems were inadequate and needed to be rethought.

Key Results

  • A working paper, "Five Provocative Points about Bringing the Benefits of Information Technology to Health Care," discussed the weaknesses of current electronic records systems and described features of a better system.
  • A paper, "Information Technology and Primary Care," summarized an expert meeting devoted to how information technology could support the various functions of primary care.

Funding

The Robert Wood Johnson Foundation (RWJF) supported this project from July 2005 through October 2006 with a $45,135 grant.

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The Problem

A study published in 1998 found that the use of electronic medical records in hospitals reduced serious medication errors by 55 percent. (Bates, Leape, Cullen et al, Journal of the American Medical Association, 280(15): 1311–1316)

In 2004, President George W. Bush declared that every American should have an electronic medical record within 10 years, arguing that computer technology would reduce patient errors and save billions of dollars through improved efficiency. (New York Times, February 18, 2007)

Despite their perceived promise, however, electronic records have not been widely adapted by the medical profession. A 2001 survey for the Commonwealth Fund found that only 16 percent of primary care physicians and 11 percent of specialists had adopted electronic records in their practices. Many physicians find the electronic systems costly and cumbersome, and are unsure whether the benefits of these systems will justify their investment.

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RWJF Strategy

RWJF supports research into and promotion of the use of electronic health records. In 2003, with RWJF grant support, Health Level Seven created an electronic health record system, as well as security standards and communications protocols. Health Level Seven created the Electronic Health Record System Functional Model, and several major industry stakeholders adopted the functional model as a standard for their own companies.

RWJF provides grant support for Connecting for Health, a "common framework" which allows communities and organizations to securely exchange electronic health information. This public-private collaborative of more than 100 organizations working together to find the best ways for health care providers to safely and securely transmit patients' medical information electronically within and among health care networks includes the American Medical Association, National Consumers League, General Electric, IBM, National Institutes of Health and the Blue Cross Blue Shield organization. The Markle Foundation initiated Connecting for Health 2001; RWJF became a co-funder in 2004.

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The Project

Gordon T. Moore, M.D., M.P.H., is a professor in the ambulatory care and prevention department at Harvard Medical School and Harvard Pilgrim Health Care. This 2005 grant funded Moore's examination of whether available electronic medical records systems were an adequate platform for reforming medical practice. The project was to include an in-depth case study of one primary care practice that used electronic records followed by a small conference of experts to identify next steps.

In July 2005, Moore conducted a site visit to Greenhouse Internists, P.C.—a primary care practice in the racially and economically mixed Mt. Airy neighborhood of Philadelphia—to study how electronic records affected patient care. Greenhouse physicians had recently written an article describing their experiences with electronic records, "Electronic Health Records: Just Around the Corner, or Over the Cliff?" (Annals of Internal Medicine, 143(3): 222–226, 2005)

Based on the site visit, follow-up discussions and research, and his own experiences with electronic records, Moore drafted a working paper, "Five Provocative Points about Bringing the Benefits of Information Technology to Health Care."

After finishing the paper, Moore decided that before an expert group could discuss electronic records, it would have to identify the core functions of primary care and then consider how information technology could improve efficiency and patient care. That became the focus of an all-day meeting of eight experts at the offices of the American Board of Internal Medicine in Philadelphia on June 14, 2006. A second paper summarized the meeting.

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Results

Moore produced two unpublished papers:

  • "Five Provocative Points about Bringing the Benefits of Information Technology to Health Care": In this working paper, Moore noted that commercial electronic record systems require doctors to input their medical notes in a rigid format. This approach is time-consuming and offers little benefit to patient care, he argued. He then highlighted four features of a system that would be more effective and less expensive to implement:
    • It would ensure universal connectivity for all providers and hospitals.
    • It would require providers to input orders, rather than full medical histories.
    • It would integrate and track the hundreds of transactions involved in caring for a patient.
    • It would support a database to measure performance and permit research into possible improvements in care.
  • "Information Technology and Primary Care": This paper summarized the discussion at the expert meeting that took place on June 14, 2006. It argued that information technology could shift more responsibility and control to patients for routine care, allowing primary care physicians to concentrate on more complex care needs and helping patients manage the overall health care system. Information technology could have several applications:
    • Informational continuity: Ensuring complete access to all of a patient's medical information, wherever he or she is being treated.
    • Workflow management: Reducing inefficiencies in processes like referrals and orders, and keeping track of care plans and the progress of treatment.
    • Clinical decision support: Presenting patient information consistently and providing physicians with up-to-date, evidence-based information about symptoms, diseases and treatments.
    • Patient computing: Supporting self-management of chronic conditions and allowing patients to handle much of the logistics of their own care (such as appointments and prescription renewals).
    • System improvement: Providing data for improving both the quality of care and the effectiveness of the health care system.

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Afterward

Initially, Moore planned to publish the findings of his case study and conference. By the end of the project, however, he had decided on a different approach: "…the obvious conclusion from this small grant was go out and design something, [T]his wasn't going to change academically…it was going to have to change by people going out and working in their garage like Hewlett and Packard did."

Since the project ended, he has traveled to Great Britain to learn about how electronic records systems were designed there with significant input from working general practitioners. He has also begun working with an Israeli software firm on designing a new electronic records system.

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GRANT DETAILS & CONTACT INFORMATION

Project

Studying the Use of a Commercial Electronic Medical Record in a Primary Care Practice

Grantee

Harvard Pilgrim Health Care Inc. (Boston,  MA)

  • Amount: $ 45,135
    Dates: July 2005 to October 2006
    ID#:  052901

Contact

Gordon T. Moore, M.D., M.P.H.
(617) 509-9973
Gordon_Moore@harvardpilgrim.org

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Reports

Moore, Gordon T. Five Provocative Points about Bringing the Benefits of Information Technology to Health Care: A Working Paper to Stimulate Discussion at an Invited Conference, 2005. Available online.

Moore, Gordon T. Information Technology and Primary Care, 2006. Available online.

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Report prepared by: Will Bunch
Reviewed by: Robert Narus
Reviewed by: Marian Bass
Program Officer: Nancy Barrand