"I guess it takes a village to attack all of the more behavioral-related and adherence-related issues that are most relevant to patients when they're living outside of the doctor's office, which is virtually 100% of the time," said Cebul, who is the director of Better Health Greater Cleveland, a nonprofit healthcare alliance focused on improving the health of chronic disease patients in Northeast Ohio.
Personal health records can help, he said.
"The personalized health records in big electronic medical record systems … enable patients to see their results, to see what is needed in terms of either health maintenance or monitoring of a particular condition, to communicate with their provider when in their home," Cebul said. Giving patients access to the ways in which doctors are thinking about their care and the results of their care will help engage them.
Electronic prescribing is another potential tool.
"When we prescribe medicines, we expect or hope that the patient will fill the prescription. In the new world of e-prescribing, there will be mechanisms by which we will be able to determine adherence to medications," Cebul said. "That will help us to recognize reasons for less-than-optimal control of chronic conditions and help engage the patient a little bit more effectively."
Strengthen connections of all kinds
Diabetes patients, in particular, need a lot of services that aren't always provided by their primary caregiver. It's easy to lose track of those visits with paper health records. In fact, it's difficult to track them even with electronic records, since those specialists don't often have EHRs of their own and, when they do, those EHRs are not always connected to the primary care provider.