Electronic Health Records should be more than just records
When we implemented an electronic record in a large multispecialty group by in 1998, it was called an electronic medical record. The focus at the time was how to recreate the paper record electronically. We were focused on how to use the data that was collected to improve care, but it was still a record more than a decision support tool.
Now the name has changed from an electronic medical record to electronic health record to broaden the view, but the word that’s really the problem is “record.” We’re focused on how to collect and store the patient information we collect electronically and show it easily the next time we see the patient. But even if we do this very well, it won’t improve the care we deliver because there’s no real incremental benefit other than ease of seeing information. Though this is an improvement, it will not get us home.
There are many issues in thinking about EHRs in their present form. They are not collecting and storing the information that is truly needed to deliver value to those we serve. The data we really need are the non-clinical determinants of our patients’ health. We also need to be collecting the factors of the community in which they reside and use that information to help us make better decisions.
EHRs are also not using all the collective information to help with decision support. Sure we get alerts, but this is a model of avoiding issues versus aiding us in making a better decision. As a hypertension specialist, my EHR had enough information in it to give me a predictive model of which medication would work better based on the patient’s age, sex, ethnicity, etc. It would look at all the information, including follow-up blood pressure levels, and help steer me in a better direction. We do this type of modeling intuitively, but we are not capable of remembering all the data points. Another issue is that data is not collected on the non-clinical providers that care for our patients. For example, how many EHRs collect data on whether or not the primary care giver understands directions given?
The EHR of the future will not be called a record. It will be more of a true decision support tool. It will collect data that the patient enters. It will ask questions that are non-clinical in nature. It will give us differential diagnosis and probabilities of likelihood. It will use our own practice styles to help direct care. It will incorporate evidence-based modeling and layer it on top of the care we deliver.
We see the beginnings of these capabilities in many different types of products, but not to the extent we need. Do not get me wrong, I think the present situation is much better than back in 1998, and that our systems will continue to evolve. However, I also believe we must demand such an evolution from our vendors. We must tell them what we need to be better value creators, and clinicians. We must think about all these issues every day. We should be the drivers of electronic change and not sit back and wait for the solutions to just appear.