Response to Harvard Business Review Article: It’s Time for a New Kind of Electronic Health Record

March 2, 2021

I just reviewed the Harvard Business Review piece by John Glaser on the topic of electronic health records (EHRs).  I must say I find it quite insightful, and I’m hard pressed to find anything I can quarrel with.  First, he calls out the fundamental transactional nature of the typical EHR.  As stated, this is in part due to its legacy of descent from billing systems.  But it is also rooted in its historical mimicking of the conventional paper chart.  It was used as a storage medium merely for documentation of information relating to an individual’s medical history: visits, labs, diagnostic imaging, pathology reports.  It was never designed to be “intelligent;” or to represent a care plan.

I love that he invokes a solution that is “intelligent and plan centric.”  I am biased though, because this perfectly describes the Enli Intelligent Care Plan: using the data in the EHR, combined with algorithms, to create automated decision support that incorporates clinical guidelines and evidence applied to a patient’s individual circumstances.

Although the title of the article invokes a “new kind of EHR,” the author also calls out the “stupefying cost” of implementing a new system; let alone the cost of re-inventing the whole application.  This leads to a discussion of a faster, less expensive approach: deployment of complementary applications that add the needed functionality.  But they must be capable of seamless integration with the EHR; using the data and presenting a user interface such that the user need not toggle to a second tool.

We know that EHRs contribute significantly to the current physician burnout crisis.  But I have participated in a number of EHR implementations and conversions, and I can attest that they impose a large and permanent negative impact on physician productivity.  Isn’t technology supposed to make us more efficient?  Applications that search the record and automatically apply algorithms in the creation of an individualized care plan are delivering on that promise.

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