JAMA Commentary: Consider De-implementing EHRs to Improve their Function

Existing electronic health records (EHRs) are not living up to the promise of improving care through predictive analytics and personalized care, according to an op-ed published in the Journal of the American Medical Association.

Current EHRs are capable of helping physicians with forming a diagnosis, monitoring a patient’s progress and treatment for that diagnosis. However, as implemented, physicians don’t use EHRs to look at a patient’s risk factors for a condition based on a database full of patients with the same condition, according to the JAMA article “Evolutionary Pressures on the Electronic Health Record.”

“For instance, when a 55-year-old woman of Asian heritage presents to her physician with asthma and new-onset moderate hypertension, it would be helpful for an EHR system to find a personalized cohort of patients (based on key similarities or by using population data weighted by specific patient characteristics) to suggest a course of action based on how those patients responded to certain antihypertensive medication classes, thus providing practice-based evidence when randomized trial evidence is lacking,” the authors wrote.

The column also bemoans the common health information management (HIM) professional headaches with EHRs, such as “note bloat” from overuse of the copy and paste function, as well as alert fatigue. Industries such as the airline industry have been able to reduce alerts pilots see, resulting in fewer interruptions, for example.

The biggest weakness of EHRs is their inability to capture the social and behavioral aspects of a patient and how factors such as their community help determine the care they receive. This means physicians aren’t seeing the patient’s total “story.”

The authors ultimately suggest “de-implementing” the EHR, which would free up physicians to listen better—and improved listening ability can help prevent diagnostic errors, the authors argue.

“There is building resentment against the shackles of the present EHR; every additional click inflicts a nick on physicians’ morale. Current records miss opportunities to harness available data and predictive analytics to individualize treatment,” the authors wrote. “Meanwhile, sophisticated advances in technology are going untapped. Better medical record systems are needed that are dissociated from billing, intuitive and helpful, and allow physicians to be fully present with their patients.”

Click here to read the full column.

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