Michael Dowling: To unlock the potential of EHRs, let's start from scratch

Electronic health records have helped healthcare organizations move on from paper-based record keeping and reduced errors while enhancing compliance, but there has been no real transformation of this technology since the 1970s.

To fully leverage the potential of EHRs, we must fundamentally rethink their purpose and create the dynamic, patient-facing tool that the current healthcare landscape calls for.

I don't want to gloss over some of the very real benefits of EHRs.  Anyone who has worked in healthcare long enough can certainly appreciate how much easier information sharing has become, and how the development of EHRs greatly aided care coordination efforts. However, this technology was primarily designed to document billing compliance, never to dramatically change the way care is delivered. Many clinicians are frustrated because they see the potential of EHRs, which is a far cry from their most basic premise.

It's important to make the distinction between EHRs, which capture patients' medical information, and personal health records (PHRs), which are information repositories that patients own and control that also extract some pertinent data from EHRs. Unfortunately, there are significant shortcomings with both, Current-generation EHRs need a lot of work to improve the user interface, data integration and other facets. Current versions of PHRs enable patients to track basic information, but they still fall short in integrating data from multiple providers and organizing it in user-friendly way.

Beyond giving nurses and physicians information about medical diagnoses, it's critically important that whatever tools we rely on shed light on patients' personal circumstances. By illuminating social, environmental and lifestyle factors that are influencing patients’ overall health, a more-comprehensive EHR would arm clinicians with the knowledge to better address some of the underlying issues that are contributing to chronic medical conditions.  

At Northwell, we have begun trials to incorporate a social vulnerability index as part of our EHR. This not only gives clinicians a better understanding of the whole patient, but strengthens relationships between all parties. Capturing diagnoses within the EHR related to the social determinants of patients' health is not only an important factor from a clinical and outcomes perspective, it also allows for seamless information-sharing with other stakeholders to drive policy changes and overall improvements in value-based care. In addition, integrating innovative technologies such as artificial intelligence/machine learning within EHRs would enhance patient care, enhance work efficiency and workflows, and improve satisfaction among both patients and providers. 

 Today's consumers are accustomed to instant access to a wide variety of services in the palm of their hands; there is no reason for healthcare to be any different. Patients should have online access to their personal health information, while also having the ability to upload pertinent background that’s useful to their providers.

When patients know the details of their health and the risks they face, there’s a better chance that they’ll make an effort to change their lifestyle and take corrective action.  

EHRs require more than a few small workarounds or a bit of rehabilitation – they need wholesale transformation that can only be achieved with the end goal in mind. Rather than think about what changes can be made to EHRs as they currently stand, we must think about the greatest needs of clinicians and patients, what tools are required to address those needs and how they can be incorporated into a new model of an EHR.

What's needed is a user-friendly tool that integrates artificial intelligence and other emerging technologies that capture and share data that patients and clinicians need and want. Perhaps most importantly, the EHR of the future must empower patients to take charge of their health, giving them access to digital tools like automated monitoring and wearable devices.

This is not low-hanging fruit or an easy win. Rather, it's a paradigm shift that will help define a new age of clinical excellence.

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