While continuing to poke around on the HealthSystemCIO site today (thanks to the Clinical Groupware Collaborative for the pointer, BTW), I came across a very insightful piece from Dan Morreale on the possibility that stand-alone EHRs may be obsolete.
Without a doubt, EHRs play a vital role within our traditional healthcare delivery model, characterized by independent physician practices and well-defined care delivery systems. As the pace of change has accelerated, however, we have to question how well the EHR — as a stand-alone information silo lacking longitudinal context — is able to handle the demands of coordinated delivery models. It’s time to forget and rethink the model.
Essentially, the problem with existing EHRs is that they are a) hospital-centric, and b) payment-oriented.
Hospital centricity means they are targeted at the large enterprise rather than small businesses like most primary care practices and IPAs). An enterprise can impose software on their employees. A small business must have systems that their staff (especially clinicians) find useful, and most EHRs aren't especially useful to primary care providers (PCPs) in the patient encounter.
Nor were they designed to be -- I'm not roasting the EMR community for designing to the requirements of their target market. A PCP's information requirements are very different from those of the specialist or hospitalist dealing with a patient in the hospital for (in most cases) a previously diagnosed condition with a pre-existing plan of care. PCPs deal with often-nebulous complaints that may take more than one visit to pin down into a definitive diagnosis.
Moreover, care planning for the ambulatory patient, especially those with multiple serious chronic conditions, must take many more factors into account than the in-patient setting. The patient's home- and community-based informal and paraprofessional support network must be taken into account. Those traditional EHRs that capture such information, and not all do, may nonetheless fail to provide timely access to it.