A former health system leader has laid out an interesting argument for refocusing EHRs on supporting care plans rather than simply documenting what care has been provided. Of course, there still seems to be considerable resistance to moving completely away from their original focus on billing, but that doesn’t mean we shouldn’t hope!
In this case, we have some worthwhile recommendations from John Glaser, a lecturer at the University of Pennsylvania, former CIO of Partners Healthcare, and formerly at Siemens/Cerner. In a recent piece for the Harvard Business Review, he explains why providers need a new breed of EHR, one which would “transition from an emphasis on a person’s medical record to an emphasis on a person’s plan for health.” Sounds a bit like the Care Pathways that Lumeon uses.
This new “plan-centric” EHR would offer several tools and options which are not available on current EHR systems, including:
- A rich library of care plans designed to address individual patient challenges, with the capacity to say, offer a different plan to a diabetic whose illness was well-managed than one supporting a patient still working to control their condition.
- Algorithms which dig into the range of issues patients may face (such as a mix of asthma, depression and obesity) and automatically develop a master plan for these patients
- Tools making these plans and to-do lists available to all members of the patient’s care team
- Support for having the plan travel across all of the care settings, geographical locations and EHRs a patient may encounter
- Decision support tools and workflow logic which remind care team members of upcoming and overdue activities, suggest changes in the plan when needed and routes messages to the appropriate team member
- Analytics for both individual patients and populations which assess how well the plan is meeting its pop health goals
This approach could offer immediate benefits, Glaser writes. For example, he suggests, EHRs structured along these lines could make it easier to care for COVID-19 patients. Providers would have access to current evidence-based treatments relevant to that specific patient’s status and underlying health conditions. As they implemented care plan recommendations, the system would report on how each patient responded to such care, intelligence which could prove particularly valuable in continuing to evolve care strategies as our understanding of the virus improves.
Now, back to cynicism land. While these seem like good ideas, I’m not sure how likely it is that vendors of current “big iron” hospital systems, in particular, would be prepared to move in this direction.
As Glaser notes, EHRs were originally designed to document transactions such as patient consults and laboratory tests, and over the last decade, this approach has become deeply embedded in their design. Though physicians rightfully complain about the systems’ billing orientation, no amount of complaints seem to have been enough to force real changes in this approach.
That being said, perhaps this will be another area in which COVID-19 care demands blow by traditional limits and force changes to how future EHR platforms are developed. It’s hard to argue against this model possibly helping providers deliver better care consistently.