Dr Derek Raghavan: Ensuring Guidelines Are Implemented and Followed

Electronic health records can be used to measure and record how guidelines are being implemented and followed, but more government intervention is needed to regulate electronic health records and set standards, Derek Raghavan, MD, PhD, FACP, FRACP, president, Carolinas HealthCare System's Levine Cancer Institute.

Once guidelines have been implemented, what strategy should be in place to ensure they are consistently followed?
I think the key is measuring the use of guidelines and the type and patterns of treatment. We now, with all the electronic health records available, have mechanisms to measure what actually happens. Oftentimes, that isn’t done, so it becomes very important for physician leaders, the leader of the pharmacies that supply medications—either to individual practitioners or to group practitioners—to actually work together to measure outcomes, to record outcomes, and to know exactly what is being done.

We’ve had, over the years, a bit of a tendency of what you might call laissez-faire—leaving the people alone, hoping they’ll do the best job they can. And that’s a good implicit concept, but now that we have mechanisms to measure what we’re doing, we need to do that and then to implement those measurements, to understand the results of what we’re doing.

One of the biggest challenges is that so many of the electronic health record systems are so hard to use, they add a lot of working time to the average clinician’s day. And, unfortunately, most of the electronic health records are sold without any measure of government oversight or any requirement for the records to produce what they promise. So, this is going to have to be an area where government gets more actively involved in.

Today, you can sell an electronic health record, as far I know, to anybody. Given that it can have such a big impact on the delivery of healthcare, it’s probably time, in the same way that the physicians and the pharmaceutical industry are being regulated, I think it’s time for the government to start to look at the companies that make electronic health records and set standards of what they need to produce. That, in turn, will allow a much better level of systematization of care.
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