Making the transition from paper to digital
Electronic health records (EHR) allow for medical care being delivered to be looked up, and the impact, which could be effective in non-communicable diseases – obesity, diabetes, cardiovascular disease – where today there is limited information about these diseases, which are at epidemic proportions in The Bahamas, according to Graham Whitmarsh, National Health Insurance (NHIA) managing director, as they went live with a new web-based system.
The NHIA last week spoke to the move to EHR and going paperless with the system in which the medical records of each patient enrolled in National Health Insurance (NHI) will be entirely digital.
Dr. Tyneil Cargill, Bay Street Medical, one of five NHI physicians that participated in the pilot system, said the new system has allowed for the transition from a pre-internet era of medical care into evolving with the internet advancements.
“It allows a physician to now be a part of the evolution of technology in medicine in providing both safe and well-documented and a continuum of care – connecting the doctor not just at the visit, but also in relation to a continuum of care outside of the practice.”
Cargill said there is interaction between physicians after the patient enters their portal and accesses their records confidentially. He said the system allows for the physician to be able to go into files electronically and follow the patient and their management, whatever protocols have been placed on a particular patient and follow them through. He said the system assists the government in preventative care in helping to reduce health costs.
Physicians and patients access the system over the web, which officials said means it’s resilient when it comes to natural disasters like hurricanes, as there is no infrastructure on the ground, and the physician can interact with the patient electronically.
According to NHIA officials, the model that NHIA has is a modern method of paying for primary healthcare.
Physicians register and decide how many patients they want to have – which could be a full complement of patients at 2,000. NHIA then makes a payment every month to the physician based on the age, gender and geographic location, as the cost of primary health care is fixed. Whitmarsh said the average cost per patient on New Providence is $15.60 per beneficiary, per month, which he said is cost effective.
The system is paid for on a per physician per month basis. The average cost per beneficiary (patient) is about $4 per year, according to NHIA authorities, and it is being offered at no cost to the public.
Electronic health record is a digital version of a patient’s paper chart, and are real-time, patient-centered records that make information available instantly and securely and has been launched with the National Health Insurance Authority (NHIA). Every person enrolled in the National Health Insurance program, and subsequently every person enrolled in both the public and private sector in the primary care program, will have one common electronic health record on the same digital platform.
“This paperless approach to delivering primary healthcare, for the patient, at any one point in time, means a doctor can tell exactly the health status of the patient and can know how better to improve the care, how better to monitor the patient, but more importantly going on to a population basis, can actually at any point in time, be able to determine the extent of the health of the population,” according to Dr. Robin Roberts, NHIA chairman.
“We can look at the present diseases, how commonly they are occurring, what is their prevalence within the community, and that allows us to shape programs in order to better the health of the community.”
NHIA is seeking to have some 250,000 people enrolled in NHI by the end of 2020, with the intent that one day everybody would be enrolled, and that there would be one electronic medical records system.
In the paperless system, a patient arrives at the clinic, registers by using an iPad; the physician during the encounter will enter information into the health record, and immediately the beneficiary will be able to see that visit in their personal health portal. If there were results from laboratory tests, or prescription, then they would be able to go in and see that. “That means they will have much better visibility to the care that they’re getting,” said Roberts.
All the clinics involved with NHI are able to use the system. And physicians who have both the private practice and an NHI practice are able to use it for their private patients as well, as they seek to get as many people on the system as possible.
“Our ultimate objective is to have everybody on a single health record.”
With over 20,000 patients already using the EHR, by October, it is anticipated all NHI clinics will be enrolled and using the electronic health record.
Whitmarsh assured of the program’s privacy and security.
“I want to be clear – no one at NHI, and no one in the government, can see any patient’s health record. Access to that information is controlled by the physician and the patient – no one gets to see it without the patient’s permission. The information is owned by the physician, just as a paper record is today, but it will give a beneficiary much better insight into the care that they’re getting, the prescriptions they may have, allergies, other elements of their care through a web-based portal, which will make their experience of getting healthcare much better.”
NHIA has acquired the eClinicalWorks system for its electronic health records. NHIA authorities say they have gone to extensive lengths to make sure the system is implemented on standard hardware, so it’s easier to support.
The data is stored in Massachusetts on encrypted servers at a facility governed by the United States Health Information Protection Act, which Whitmarsh said has some of the most stringent standards in the world.
“We have gone with a mainstream system and to us it’s great comfort they’re governed by those rules in the States, because I think we would have struggled to achieve those levels of security here,” said Whitmarsh.
Roberts said the move to EHR and away from paperless is a bold and ambitious program at NHI as they seek to have every Bahamian in the country have their own primary care physician, general practitioner or family medicine specialist, so that whenever they have any health problems, they have immediate access to a physician; and their healthcare records will be in a digital form.
“We are seeking that every person enrolled in our program, and subsequently, every person that’s enrolled in both the public and private sector in the primary care program, will have one common electronic health record on the same digital platform,” said Roberts.
“For the patient, at any one point in time, the doctor can tell exactly what is the health status of the patient, so therefore he/she can know how better to improve the care, how better to monitor the patient, but more importantly, we are going on to the population basis whereby we can actually at any point in time be able to determine the extent of the health of the population. We can look at the present diseases, how commonly they are occurring, what is their prevalence within the community, and that allows us to shape programs in order to better the health of the community.”
With the digital system, Roberts said physicians can be held accountable for the care that they deliver.
“At any point in time we can look to see what services are being rendered – whether they’re being done on a timely basis, whether we’re getting the outcomes that we want in our patients, because central to our electronic health records, we have the input of the Pan American Health Organization with some 50-plus healthcare key performance indicators that can tell us exactly how we are monitoring the health of our people.”
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