Health Information Technology Archives

Learning health for Michigan: The path forward

A physician in blue scrubs points at a screen with tiles showing health symbols, a representation of a health learning system.

In the United States, health care purchasers, consumers, and policymakers are demanding improvements in the quality and efficiency of medical care. A promising approach to meet this demand is the development of what is known as a learning health system (LHS). A learning health system has the capability to continuously study and improve itself. Among many types of benefits it can bring about, the learning health system makes it possible for providers to make faster and better decisions about which treatment options would produce the best outcomes for patients.

Today, the Michigan-based stakeholder initiative, Learning Health for Michigan (LH4M), is proposing the use of a learning health system approach to address persistent health care problems in Michigan. Unwarranted and costly hospital readmissions—which are discussed in this paper—are one example of a problem that could benefit from a learning health system approach.

In 2013, the Center for Healthcare Research and Transformation (CHRT) convened a group of patients, clinicians, researchers, public health professionals, and payers to discuss ways to apply the idea of the learning health system at a state level: to turn Michigan into what might be called a “learning health state.” The initiative was named “Learning Health for Michigan,” or LH4M. Later convenings of the LH4M stakeholder group were organized by the Michigan Health Information Network (MiHIN) Shared Services and the Department of Learning Health Sciences at the University of Michigan Medical School.

Michigan has many resources that are key ingredients for a state-wide learning health system.

READ THE BRIEF

EHR Interoperability and Patient-Centered Care

Image of a screen showing an EHR, with "Medical record" written on top of the page.

In 2009, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act to modernize the U.S. healthcare system through the implementation of Electronic Health Records (EHRs), software systems that create a digital version of a patient’s medical chart. HITECH incentives accelerated widespread adoption of EHRs. However, the ability to exchange information between different EHRs across various healthcare settings — known as interoperability — was not a key requirement when the digital systems were first developed. Eight years later, EHRs are in place at almost 80 percent of physician offices and doctors are increasingly reporting that interoperability is important. Data from the Center for Healthcare Research and Transformation (CHRT) Michigan Physician Survey shows primary care physicians (PCPs) consider interoperability an important feature for providing patient-centered care.

Our data show a significant change in just two years in the perception among PCPs of the value an EHR with interoperability can play in patient care. In 2014 and 2016, CHRT’s Michigan Physician Survey asked PCPs how important having an EHR with interoperability was to their ability to deliver patient-centered care. Significantly greater proportions of PCPs in 2016 said it was “very important” to have EHRs that are interoperable between hospitals and practices, and practice to practice. There was no significant change in the proportion of physicians who saw just having an EHR in their own practice as “very important.”

READ THE BRIEF

E-prescribing: Barriers and opportunities

Electronic prescribing (also known as e-prescribing) is a system that enables providers in health care settings—e.g. doctors’ offices, hospitals, and long-term care facilities—to electronically write and store prescription information and send it directly to pharmacies.

There are two main types of e-prescribing systems:

Systems integrated with electronic health records, which include comprehensive patient information.
Stand-alone systems, which are less costly and easier to implement.

Some e-prescribing systems also include advanced features that allow health care providers to access generic medication alternatives, drug formularies (insurance benefit information), and patients’ medication lists and histories (to check for drug allergies and interactions). These advanced features have the potential to enhance physicians’ decision-making capabilities and increase their use of e-prescribing.

Advocates of e-prescribing tout its potential for improving patient safety and lowering health care costs. Research indicates that e-prescribing is indeed a useful intervention for reducing the risk of medication errors and adverse drug events in hospital settings and increasing the selection of effective, less costly medications for hospitalized patients, but there is less evidence of its effectiveness in reducing medication errors in ambulatory settings.

In the changing health information technology environment, various public-private collaboratives and state and federal initiatives are underway to encourage the adoption and use of e-prescribing among providers. In 2010, 25 percent of eligible prescriptions were sent electronically in the United States. Michigan ranks second in the U.S. for e-prescribing based on the following three factors in the e-prescribing process: 1) the percent of patient visits involving a prescription benefit request; 2) the percent of patient visits involving a medication history response; and 3) the percent of eligible prescriptions routed electronically. In Michigan, 20 percent of eligible prescriptions were ordered electronically in 2009, up from only 4 percent in 2007.

Although its use is increasing, providers continue to encounter significant barriers to the implementation and effective use of e-prescribing systems. It is important to understand these challenges in order to ensure the widespread adoption and effective use of e-prescribing.

READ THE BRIEF

Publications