EHRs Featuring Long-Term Goal Could Improve Health Outcomes

Too often, the design of electronic health records (EHRs) for primary care reflect why and how care is being delivered—with an emphasis on how it’s reimbursed and for short-term, acute needs. If health IT developers designed EHRs with long-term, goal-directed healthcare in mind, primary care providers would be better equipped to help their patients, according to researchers at the University of Oklahoma Health Sciences Center Department of Family and Preventative Medicine.

“Unfortunately, most EHRs have been designed in a problem-oriented and fee-for-documentation framework, which reinforces a corresponding care approach,” writes the study’s author, Zsolt J. Nagykaldi, PhD, in the Annals of Family Medicine. “Historically, most electronic records in the United States were developed in medical billing organizations that extended their systems to include clinical documentation. It is therefore not surprising that the underlying design of these systems supports the management of medical problems and the tracking of procedures in order to calculate the value of health professionals’ work.”

Primary care physicians are the best suited to track an individual’s health over time by coordinating and collaborating with their patients’ other providers, the study noted.

“Complex primary care requires personalization and prioritization based on the specific needs, goals, and circumstances of individuals. Current medical records are ill-designed to support longitudinal, personalized health care provided by diverse professional teams in multiple settings and times,” Nagykaldi wrote.

He and his partner developed and tested a comprehensive test planner that asked patients questions based on 13 health domains tailored to their individual health goals. The planner also included functionality that allowed physicians to provide feedback on patient goals. The investigators acknowledge that that the healthcare paradigm will take time to change and that major EHR redesigns aren’t likely to be possible in the near future.

“Even if medical records cannot be fundamentally redesigned at this point, inclusion of the core patient profile and health planner functions and creation of linkages between patient characteristics and other parts of the EHR could help us move toward a goal-directed health record,” Nagykaldi said.

Mary Butler is the associate editor at The Journal of AHIMA.

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