Health Information Technology in the Era of Care Delivery Reform

To What End?

This Viewpoint, published in the Journal of the American Medical Association, argues the debate on whether to create electronic health records (EHRs) is outdated and should now focus on how EHRs, which are inevitable, can support new care models that promote broader health care policy goals. Those current models include accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). Current EHR schemes are generally built to support existing fee-for-service systems.

Key Points:

  • The success of ACOs depends on a broad care team all having timely information that allows them to manage care so that it is efficient, effective, and less fragmented. Therefore, EHRs must be designed to promote interoperability and information exchange across sites of care (including from specialized facilities, such as rehab hospitals and nursing homes, that have been slow to adopt EHR); real-time quality and cost measurement; and powerful analytics.
  • The success of PCMHs relies on the same information requirements as ACOs, but also needs EHRs to promote teamwork among clinical caregivers, and engage patients in their own health care.
  • For the team to use each member’s time and skills optimally, EHRs should provide functional aids, such as clinical messaging, task sorting and shifting, and list creation.
  • Involving patients in their own care requires features that promote patient-physician communication and that present clinical data in a manner that patients with “poor health literacy” can use.

The authors note that the function of EHRs is to meet the needs of clinical teams and patients in models that provide “safer, more integrated care that engages patients and reduces costs.” Thus, the form of EHRs should follow that function.

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