EHRs need overhaul to 'plan-centric' systems, former Partners CIO says

Plagued with user interface and interoperability issues, EHRs are overdue for an overhaul and redesign to transform them into systems that support new value-based care business models and proactive management of patients' health, according to John Glaser, PhD. 

In a June 12 viewpoint article for Harvard Business Review, Dr. Glaser, former CIO of Partners HealthCare, now Mass Brigham, in Boston, explains that the shift to value-based care and insights derived from the COVID-19 pandemic have pushed the need to redesign EHRs to the forefront. 

The pandemic has presented the U.S. healthcare system with a "simultaneous glut and dearth of information," to track, including outbreaks, effective treatments, vaccine development and patient health status.

EHRs should be equipped with tools to sort through large amounts of information, "but we still have problems of knowing what data is important and what is the right treatment and prevention plan for each patient," according to Dr. Glaser. 

To address these issues, Dr. Glaser recommends redesigning the EHR to a "plan-centric system," which includes the following: 

1. A collection of care plans covering various patient circumstances and situations. The library would offer variations for care plans depending on the patient's preferences. For example, a patient who lived alone would have a different plan than a patient who lived with a large family and support system. 

2. Master plan formed by algorithms. Because patient issues tend to intertwine, a master plan would "combine appropriate algorithms for treating a patient's asthma, arthritis, depression and weight reduction, automatically resolving conflicts and redundancies." 

3. Care team support and collaboration. The patient's entire care team would have access to the master plan as well as their own specific tasks, which team members could assign to one another. 

4. Interoperability. Providers would have interoperable systems that could integrate a patient's master plan regardless of what hospital it was created in or what vendor software system it originated from. 

5. Decision support. The patient-centric EHR must alert care team members of upcoming and overdue activities and offer alternatives in the master plan when patient conditions or care needs change. 

6. Analytics insights. The EHR must use data analytics to track how well the master plan achieves both the patient's goals as well as for the larger population that may be under the provider's care. The system should take lessons learned from individual patient cases to treating other patients. 


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