What is actually involved, in providing good ongoing medical care to a frail older adult who is medically complex?
I’ve been thinking more about this, since earlier this week I attended a Code for America event about meaningful use. And in an interesting coincidence, Christopher Langston of the J. Hartford foundation published a blog post yesterday titled “Making Electronic Health Records Responsive to Needs of Older Adults (Really Meaningful Use).”
Now, since my consultative geriatrics practice is direct-pay and I’ve opted-out of Medicare, I don’t have to use a certified EHR that is going to help me attest to meaningful use.
Nor do I have to figure out how to qualify for the new chronic care management (CCM) payment.
But of course I use my EHR (MD-HQ) very meaningfully. And the clinical work I do meets the 99490 criteria:
- Multiple (two or more) chronic conditions expected to last at
least 12 months, or until the death of the patient,
- Chronic conditions place the patient at significant risk of death,
acute exacerbation/decompensation, or functional decline,
- Comprehensive care plan established, implemented, revised,
(The one criteria I don’t meet is that I don’t provide 24/7 access to my services, although all my patients can access their clinical information — including detailed clinical notes — via my patient portal. Because my practice is small, solo, and consultative, everyone has to have a PCP and that’s who they can call after hours or on weekends. It’s not ideal but oh well.)
Helping an older person with health is like managing a complex ongoing project
One could write a long book listing everything that goes into providing ongoing health help to an older adult. Especially since this usually means also helping family, as well as the paid individuals providing assistance.For an older adult with functional impairments, it’s easy to have a very large number of people involved, when you consider specialists, home health, family, residential facility staff, paid in-home caregivers, geriatric care managers, etc. And usually we have lots of ongoing health issues to collectively address.
So those are the circumstances in which I usually do my doctoring. In this post, I’m going to focus on what I’ve noticed when it comes to what I need from my EHR, and my personal clinical workflow.
First of all, it’s important to have a way to capture and store all the relevant data that emerges between face-to-face visits. This includes things like: [Read more…] about My Process for Meaningful Use & Chronic Care Management