Do EMR and EHR Registries Equal Better Care?

Meaningful Use includes the creation and transmission of patient registries for reporting various medical data such as vaccinations, medications, lab results and vital signs including weight, body mass index (BMI) and blood pressure.  To be honest, I don’t know any real practicing doctors out there who worry about their EHR’s ability to perform registry generation, but non-doctors with more time on their hands seem to think it’s the Holy Grail.  As it turns out, a recent post by Ken Terry EHRs Give Docs Analytics Tools They May Ignore sparked my interest.  

It was pretty intriguing that an insurance company like Blue Cross Blue Shield would be sponsoring a pilot experiment to correlate doctors’ access to EMR and EHR technology with doctors’ ability to generate patient registries.  Clearly, this is the first step in making searchable databases that will enable users to ask more detailed questions.  Since the pilot study was not clear on what or how much information was shared with the insurance company by the administrating body for the study, the Massachusetts eHealth Collaborative, there’s an interesting closed door there that the public can’t see behind right now.  Why does an insurance company want such information?  Let’s be honest:  it’s got to be money, plain and simple.  Insurance companies are for-profit entities after all.  Assigning report cards and pay-grades to doctors based on performance?  Stratifying out “good” and “bad” doctors?  Door #3?  If they just want to study problem areas for public health improvement, then it would be preferable to define their end goals publicly ahead of time — which has been one of my big beefs with Meaningful Use.

I loved the comment by Jane Metzger, a CSC consultant who is an expert in registries.  Most of today’s EHRs can do a registry-like function, but it takes work to do that… Not every practice that adopts an EHR is committed to care management–having guidelines for care, knowing who your diabetic patients are, and deciding you should see them at least once a year and so forth.”  Wow — what a negative connotation of docs who might have other ways to benefit their patients.  However, Metzger did mention something I agree with in the end:  ” it’s extra work to do it.”

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at