The Trouble with EHRs

Scott Mace, for HealthLeaders Media , January 14, 2014

"We're very interested in having patients enter their own blood sugars and blood pressures and having some mechanism of allowing them to," Linder says. "The only mechanism right now for them to correct their data is via messaging. If they notice a problem that they disagree with, currently it's not really a collaborative space, where the practice and the patient are jointly curating the information in the medical record."

Like the other providers, Partners faces its own governance challenges during this transition. "The other cultural problem we're running up against that we're going to have to work our way through over the next decade is our conception of medical care—the unit of medical care," Linder says. "Right now I work in the ambulatory setting, so we're very focused on visits still, and hospitals are very focused on hospitalization, and so the record is designed around discrete events like that."

Thus, documentation of a medical record today remains largely the story of what was done at a particular visit. "Hopefully we're moving toward a health system that's focused on taking good care of you, whether or not you happen to be in the office at that moment," Linder says. "That shifts the value from visit-based data to the latest instance of the electronic health record as the truth, and that can happen at any time. It's not dependent on a visit."

Of all the stakeholders in healthcare, the ones most concerned about how the medical record evolves are probably the health systems' attorneys. "It's our lawyers who are most interested about keeping a record of everything that happens," Linder says. "Our health information systems department is very focused on keeping a record this way."

Even now, LMR records have a "history" button next to many coded elements, Linder says. "You can kind of delve into the history and see who updated it, and how and when," he says. "But if you think about all the moving pieces in an electronic health record, every single one of those elements has some mechanism for capturing histories behind that element, and it's a lot of data that nobody really has the time or inclination to go through, so it's challenging. It's definitely challenging."

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This article appears in the December issue of HealthLeaders magazine.

Scott Mace is senior technology editor at HealthLeaders Media.
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4 comments on "The Trouble with EHRs"

fam med doc (1/21/2014 at 7:34 PM)
where is the evidence that EHR improves healthcare? what is clear is that 1) EHR transfers hard earned money to tech companies 2) wastes doctors time when more pts could be seen using paper charts and voice dictation 3) makes it easier for govt and law authorities to audit you 4) reduces profitability

Bil (1/17/2014 at 10:54 AM)
Altho this article is primarily hospital and acute care-oriented, is it time to consider proactive, previsit, medical record submissions by the patient to the provider(s), so that there visits could be more efficiently conducted?

Krishna (1/16/2014 at 8:21 PM)
I was just wondering:' where is the evidence that EHRs reduce costs? And why have these products been allowed to run the care of patients sans oversight? To where should I report the hundreds of errors that have accumulated over the past five years? Please publish your response for all to see.




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