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American Geriatrics Society I. BACKGROUND One potential bright spot for improved care of older adults is the evolvement of the electronic health record (EHR). This technology may offer an opportunity for better care at substantially less cost. While information technology alone is not sufficient to improve the quality of care, it can substantially improve the efficiency of the work process. The potential for improved communication as health information follows patients from one care setting to another could improve transitions for patients, caregivers, family members, and each level of health care provider. The opportunity for improved data collection for individual care, as well as population strategies, could revolutionize medicine and improve care oversight in a manner not seen since the birth of Geriatrics as an entity of Medicine. Unless early steps are taken to optimize the structure and function of EHR to reflect the comprehensive needs of Geriatric Medicine and Gerontology, care of seniors will fare little better than in the current health care system. As the White House Conference on Aging made clear, the time is now to provide the blueprint for information technology to adequately assure optimal care for a burgeoning senior segment of health care. Already efforts from various vendors in the private sector as well as from government-sponsored regional initiatives are moving information technology forward with an emphasis on interoperability. Geriatrics must be adequately represented with sufficient advocacy to assure that the new systems of care improve quality and reduce fragmentation of services for seniors transitioning from one level of care to another and from one health care system to another. II. POSITIONS a. Electronic Health Records must facilitate the secure exchange of patient information among various settings, including the outpatient office, home health care the hospital and long-term care facilities. b. An EHR must have inherent flexibility to change as innovations in medical care and geriatrics practice warrant changes in the health record c. An EHR system must be adaptable to working with health care providers beyond those of most clinician-focused EHR systems, which would include administrators, nursing personnel, physicians, pharmacies, and owners. This means that other disciplines more prominent in Geriatrics, such as dietary, rehabilitation services, home-monitoring (e.g., blood glucose, blood pressure, pulse, heart monitoring) vendors, must also find a way to be included in such data gathering systems. d. The EHR should be accessible to patients and authorized lay individuals in a secure fashion. This should include capacity to provide information to the practice/provider and for obtaining information, e.g. laboratory results or record review, and it should allow for a patient to download information securely into a separate personal health record or transfer information, as needed, for personal matters. e. Data entry into EHR should be in a relational database so that information is accessible for easy analysis and amenable to senior population-based queries. As such EHR should readily be able to assist quality assurance and performance assessment. A disease registry should be part of the EHR relational database. Any query function must be able to isolate data in accordance with age. f. The EHR should provide automated entry of data coded using nationally recognized standards to promote interoperability, thus minimizing the opportunity for transcription errors in transferring information from one data source to the EHR and vice versa. This should include interfacing with senior-relevant databases, e.g. the Minimum Data Set in long-term care. g. Regulatory bodies must be able to access information necessary to fulfill their mission without requiring practitioners or health care systems to provide redundant hard copies of information. This should include investigative branches, e.g. the Office of the Inspector General (OIG). h. The EHR system must be secure and have redundancies to obviate the potential loss of information in the event of a local disaster. The patient or authorized health care agent should have at least as much control over the dissemination of electronic health records as currently exists for other medical records. i. The EHR systems will be able to integrate information across disciplines as well as health care systems. Ideally, the EHR should be capable of expanding to other appropriate authorized and secure health-related settings. For example, a senior applying for handicapped accessibility could electronically transfer information to the department of motor vehicles in the state. j. EHR systems must accommodate information germane to a senior frail population, including, but not limited to, functional assessments, cognitive assessments, and information on advance directives. k. The EHR should provide prompts on prevention relevant to seniors and on potential errors, e.g. drug-drug interactions or excessive dosing, specific for older adults. l. EHR systems should include Geriatric-sensitive, evidence-based decision support with prompts related to screening and follow-up. m. The EHR should be affordable enough for geriatrics private practitioners and their patients regardless of location and practice setting. n. The American Geriatrics Society supports efforts to establish a uniform coding standard to facilitate interoperability without establishing a preference among systems currently available or under development. o. The American Geriatrics Society encourages the Certification Commission for Health Information Technology to continue to be sensitive to health care needs inherent in providing care for seniors. Continued input from representatives, e.g. the American Geriatrics Society, on the needed components of EHR to make them of greatest utility for senior populations is now, and will continue to be, necessary. Additional considerations not specific to Geriatrics: There should be a single health care provider (ideally a physician or other primary care provider who provides the bulk of care to the patient), designated by the patient, who is responsible for the updating of medical information in the EHR and who should be reimbursed separately for doing so. The EHR should be accompanied by 24-hour IT support. The EHR should allow for e-prescribing and pharmacies should be equipped to receive such information. The e-prescribing should direct prescribers to correct medication dosing and frequencies. The EHR should incorporate a real-time, comprehensive medication list that allows input with standardized coding from multiple prescribers and should, ideally include input for herbs and over-the-counter remedies. Health systems should work to accommodate information exchange among various EHR systems used to collect information on common patients. III. Credits American Geriatrics Society and approved by the AGS Executive Committee in May 2006. Written by the AGS Health Care Systems Committee, with special thanks to Drs. Michael Gloth, Ron Stock, and Alan Lazaroff. AGS, The Empire State Building, 350 Fifth Avenue, Suite 801 New York, NY 10118.
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