Can EHRs achieve the interconnectedness we need or do we need to see the rise of new, EHR-independent technologies? Dr. Robert Rowley shares his insights.
Electronic Health Records (EHRs) have come a long way in moving U.S. healthcare onto an electronic platform in the past few years. As of 2013, the majority of practicing community physicians, as well as most hospitals, have adopted an EHR system in their practices.
patient care networkLike was the case with paper beforehand, EHRs have maintained the siloed nature of health care data, keeping records within the institutions (hospitals, medical practices) that created them. This is no real surprise – EHRs, after all, are provider-focused tools. More than being physician tools, they are really better thought of as practice tools. Many of the workflows addressed by EHRs, both in hospitals and in medical practices, involve the whole in-house care team, and only a subset of an EHR’s capabilities are about physician documentation of encounters.
What is also clear, though, is that we need to move beyond the fragmentation, and connect a patient’s health data across all the places where care is sought. We need to build what has sometimes been referred to as a “community chart” – one that exists centered around the patient, not the provider, and draws seamlessly from all the provider’s EHR records wherever they exist.
Can EHRs achieve the interconnectedness we need? Or do we need to see the rise of new, EHR-independent technologies in order to reach this needed next stage?
EHRs and Enterprise Charts
One way that interconnected health data has evolved is by creating institution-wide Enterprise Charts – a single chart, accessible by everyone within a delivery system. This has become more widespread as medicine changes away from small, independent practices, and toward larger groups, both physician-owned and hospital-owned. In such larger settings, a single large enterprise EHR is common (e.g. Epic), and is deployed across a hospital and all the affiliated practices. Within the walls of such an integrated delivery network (e.g. Kaiser), a single chart available everywhere is the realistic goal of their EHR.
Whether in tightly coordinated networks, or in looser arrangements, achievement of an Enterprise Chart is no trivial matter. It involves uniquely identifying patients and merging duplicate records. This is generally done using EMPI systems (Enterprise Master Patient Index) – a whole area of software that needs to be leveraged (often at considerable cost) in order to achieve a workable Enterprise Chart.
However, even if done well, and even if there is an actual or virtual Enterprise Chart in a healthcare delivery network, this still falls short of the goal. A patient-centered, portable record that accompanies an individual through one’s life journey into and out of these integrated delivery system simply cannot be achieved within the domain of a given EHR system, regardless of how well integrated it is within a network.