In increasingly used population health arrangements, cooperating providers assume joint responsibility for the health of a group of patients, often sharing the financial risks and rewards of caring for that group.

But to what extent are physicians sharing information about new prescriptions, changes in health status, recent hospitalizations and the like? Often, this information is crucial in making an accurate diagnosis, managing a chronic condition or avoiding side effects. However, patients may neglect to mention these changes.

What’s needed, not only in population health scenarios but in any physician/patient encounter, is a complete patient record that gives providers actionable information precisely when they require it. At a minimum, that should include information about current medications, past surgeries, recent tests/procedures and chronic conditions.

Patients shouldn’t be relied upon to voluntarily supply this information by themselves. Often, the information physicians need already exists across multiple information technology systems that don’t “talk” to one another or are stored on a legacy system used so infrequently that no one readily remembers the password.

An independent clinical archive (ICA) can bring disparate information stored across multiple systems into one central repository and in a common language. From that platform, clinicians can access the information they need using the same workflows they previously have to understand their patients better and make more-informed decisions.

3 reasons physicians need complete information

Patients are the sum of their conditions and their experiences, both of which play vital roles in making diagnoses. But the key is relaying that information quickly and accurately to the physician. When thinking about diagnostic errors, you might imagine an emergency department scenario, with an unconscious patient getting wheeled into the hospital with an uncertain condition and nothing to go on but the physician’s experience, intuition and test results.

However, in the ambulatory realm, diagnostic errors are the single largest contributor in up to 40% of malpractice claims. The average payout for each claim is about $300,000. That’s with no unconscious patient or critical condition that requires a split-second decision that could mean the difference between life and death.

One issue for patients visiting group practices might be overfamiliarity with the physician or the number of doctors a person sees, the “I thought I told someone” syndrome. It can be difficult to remember which physician prescribed what, ordered that test, made that diagnosis—especially among older patients. Multiply a single visit by the number of physicians a patient with multiple co-morbidities visits in a year, and you begin to see the point. That’s why a central data repository makes sense.

Practices also are seeing increasingly number of older patients, a reflection of the graying of America where 10,000 people retire every day.

While this particular study highlights emergency department admissions, parallels can be drawn to the physician office environment. A study published in 2015 showed that 25% of patients 75-year-old and up could provide no medical history themselves. For patients where complete information could be compiled, only a small percentage of patients provided that information themselves, which was completed in about eight minutes. When family members were involved, the required time more than tripled to 27 minutes. And if outside caregivers were consulted, the required time was nearly an hour.

Finally, today’s patients are generally sicker than previous generations. Much of that, fortunately, can be attributed to increasing human lifespans and the conquering or managing of conditions that killed previous generations. Slightly more than half of us, or 117 million people, suffer from at least one chronic condition and almost one-third suffer from two or more, according to statistics from 2010. 80% of people 65 and older have multiple chronic conditions. The cost of care for those with multiple chronic conditions, regardless of age, account for 71 cents out of every dollar spent on healthcare.

For providers participating in accountable care organizations (ACOs), patient-centered medical homes (PCMHs) and other value-based population health initiatives, statistics like these point strongly to the need to know patients better. Population health is about embracing the group, with their common conditions and co-morbidities, while respecting the individual. In risk-bearing arrangements, practices can be financially liable if the health of the group suffers.

All of us are bombarded with increasing amounts of information that can be difficult to recall, particularly in the medical exam room. Add aging minds, multiple co-morbidities and clinician time pressures, and you begin to understand the difficulties that clinicians face when taking patient history.

The electronic medical record (EMR) has been around long enough that most practices are on their second, if not third or more, iteration. With each migration, some information gets lost or doesn’t come over because it’s not deemed important enough. What does come over may not get indexed in the same way as the previous system, creating gaps in the patient record.

EMR vendors want as little information as possible to come over so there can be a “clean” install. Patient information about prescriptions and allergies is likely to come over, as is scheduling information and the last six to 12 months of patient information. Other, often critical, information remains locked in the previous EMR, where access can be difficult.

But as we’ve seen, more than one-third of patients have two or more chronic conditions, which by definition can last for decades. Previous attempts to control conditions can be lost in the data migration, as can tests used as baseline measurements against current scans.

To find this information, physicians may have to log into another system or consult with tech support to find the data, wasting time and money. Once the information is located, it may not be in the format of the current EMR, so it will need to be printed out and then scanned into the current patient record.

An independent clinical archive (ICA) does not replace an EMR or PACS. Rather, it can store information from previous EMRs and other information technology systems to make that information available as part of a complete patient record. It also allows IT to retire older technology that is not being used except to call up older records, saving money and allowing staff to concentrate their efforts on supporting current technology.

Think of it as transferring your vinyl albums to a digital format. MP3 was once the standard for digital music, but it has been supplanted by new formats that have a richer sound with less loss of music quality. However, your MP3 files will still play on your smartphone or computer. Once you have transferred music from vinyl, you don’t need the physical records anymore.

A centralized, standards-based data repository like an ICA accepts such disparate data as DICOM images, HL7 broadcasts, XDS files and other unstructured data types. Data is stored in a common format that can become part of the patient record through an application programming interface (API) between the ICA and the EMR. APIs can be used to link legacy systems to the EMR, too, but those connections often are tenuous because of security concerns with older technology and lack of common language between information systems.

When properly implemented, the physician doesn’t recognize what information is coming from the EMR and what information is being pulled from the ICA. For him, it’s one patient record and one set of information that can trace office visits, prescriptions, tests, diagnoses, chronic conditions, hospitalizations, surgeries and more for as far back as patient records exist.

Future ideal of healthcare

Population health through such programs as ACOs and PCMHs represent the future ideal of healthcare, with the development of best practices for patient groups within the population while still recognizing the individuality of each patient. But it can be difficult to coordinate care with other providers as a patient visits specialists, has tests, undergoes surgeries, goes into the hospital and requires rehab following an inpatient stay.

Much like digital music has become the standard for audio files, the independent clinical archive can represent the standard interface between the current EMR or PACS and past patient records that still hold considerable diagnostic value. By converting old records into a common format, a physician can access historical information as easily as he can review today’s visit.

That information can be shared with other physicians and specialists, resulting in better diagnoses and patient care.

Stephen Matheson is vice president, product and sales for BridgeHead Software

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