Mayor Michael R. Bloomberg and Health Commissioner Dr. Thomas R. Frieden today unveiled the City's next-generation electronic health records (EHRs), already in use at more than 200 primary-care providers across the city that care for more than 200,000 New Yorkers. Amidst a growing national debate about how to fix the health care system, the City is on track to meet its goal of equipping more than 1,000 local health care providers - many of them practicing in the city's poorest and sickest neighborhoods - with secure EHR systems by the end of the year, benefiting more than a million patients.
This effort will create the nation's largest community-based EHR network and is a step toward a new kind of health care system that puts the focus on prevention rather than treatment. The Mayor and Commissioner Frieden were joined at the announcement by New York State Health Commissioner Dr. Richard F. Daines, City Council Member Joel Rivera, and Dr. Sumir Sahgal, a physician whose Bronx practice has adopted the new technology.
"Electronic health records that put prevention first are a necessary but not sufficient step to fix our ailing health care system," said Mayor Bloomberg. "Today's milestone of improved health care for 200,000 New Yorkers through EHRs puts us well on our way to delivering this innovative, life-saving technology to more than one million people in the city by the end of the year. By bringing this health technology to New Yorkers, we are building a national model for a health care system that works, by preventing illness rather than merely treating people after they're already sick. In Washington, they talk about how our health care system should be reformed; here in New York City, we are actually doing it."
"This system gives doctors the right information at the right time so they can make the right decisions and save lives," said Commissioner Frieden. "By giving doctors and patients the tools to better manage conditions such as high blood pressure and high cholesterol, we can prevent thousands of strokes, heart attacks and early deaths."
The Health Department's Primary Care Information Project, led by Assistant Commissioner Dr. Farzad Mostashari, developed the new electronic health records with the firm eClinicalWorks, which was selected through a competitive process. The new software promotes prevention by giving doctors tools that no other commercially available health record provides. With $30 million, the Health Department developed the EHRs and offers eligible practices (primary care providers with over 30% Medicaid and uninsured patients) a subsidized package of EHR software and services - including licenses, onsite training, data interfaces, and two years of maintenance and support. In return, eligible practices must bear the costs of hardware and network infrastructure and contribute $4,000 to the Fund for Public Health in New York for ongoing technical support. The Health Department is also helping non-eligible practices integrate the new prevention tools into their own EHRs. The initiative is being supported by a $3.2 million grant from New York State and evaluated through $5 million in funding from the Centers of Disease Control and Prevention and the Agency for Healthcare Research and Quality.
"We congratulate Mayor Bloomberg and Commissioner Frieden on their Primary Care Information Project," Commissioner Daines said. "Electronic health records are critical to improving health care quality and efficiency, and must be aligned with the State's proposals to link reimbursement to quality outcomes for patients in order to realize their potential. New York State is also funding a statewide health information network so that no matter where a patient is seen in New York, an authorized physician will have access to that patient's electronic health record. This represents a breakthrough for patients and doctors."
Electronic Health Records Will Help Revolutionize Care
Designed and used in the right way, secure electronic health records can help transform health care, just as information technology has revolutionized other industries in recent years. Besides improving efficiency and preventing medical errors, a well-designed electronic health record can help physicians monitor - and manage - health risks to entire groups of patients. New York City's new health record guides doctors through routine medical exams, ensuring that they provide preventive screenings, prescribe the most effective drugs, offer protective vaccines, and give smokers the support they need to quit. And by visually tracking measures such as cholesterol, blood pressure and blood sugar, the record gives doctors and patients the information they need to chart progress and maximize health.
The new health record also allows doctors to provide patient-centered care, and to monitor their own performance to see how well they are doing at providing good preventive care. This will also allow insurers and the government to restructure payment systems to favor high quality preventive care that will help reduce the need for higher-cost surgeries and treatments that occur after a patient becomes sick.
The new health record improves the quality of care. Policy debates typically focus on how to increase access and control cost - both critical issues - but they often skirt the issue of how to make health care more effective. Nationally, nine out of ten people with uncontrolled diabetes or hypertension already have health insurance, yet they still lack the support and treatment they need to effectively manage their conditions. And national studies show that patients receive only half of the preventive services they need when they visit their doctor.
The City's Health and Hospitals Corporation (HHC) demonstrated the power of EHRs when it implemented them a decade ago, winning three national awards over the past five years. HHC plans to update its EHR system to include decision-support features of the Health Department's new system, and also integrate with existing HHC technology.
At the most basic level, electronic health records convert a paper chart to an electronic one. This reduces paperwork and helps prevent medical errors. But electronic health records can also improve people's health by making preventive care the default setting. The Health Department's prevention-oriented EHRs improve health care by:
- Giving doctors the fuller picture of a patient's health by integrating the patient's medical history, lab results and current medications into one electronic interface
- Improving follow-up care by prompting the doctor's front office to send reminders to patients
- Increasing preventive screenings, such as mammograms, colonoscopies and pap smears, by providing automatic reminders during routine medical exams
- Reducing the risk of adverse drug reactions by tracking prescriptions and flagging potential interactions
- Allowing doctors and patients to track blood pressure and cholesterol control with simple charts and graphs
- Ensuring best practices and reducing errors by highlighting the most effective drug treatments (and doses) when a diagnosis is made
- Expediting care by providing instant referral when a patient needs care
- Reducing delays in treatment by sending prescriptions electronically or by fax
- Tracking medication use and identifying patients who need more assistance to take their prescribed treatment
- Tracking quality of preventive care over time, and in a comparable way between different doctors and different practices