Electronic health records (EHRs) hold the promise to improve primary health care for millions of patients. However, enhancing current EHR functionality is needed to better support primary care clinicians and patients, according to a recent article in the Journal of American Medical Informatics Association.
"The adoption and use of electronic health records could greatly improve health care and lead to better patient outcomes, yet many clinicians are dissatisfied with current EHR systems," said Alex Krist, M.D., lead author of the article and associate professor of family medicine and population health in the Virginia Commonwealth University School of Medicine. "Enhancements to electronic record functionality are needed to better support care. Primary care needs EHRs to move beyond focusing on disease and instead focus on the whole person."
Objectives of EHRs remain focused on disease, ignoring the many factors that can play a role in someone's overall health. These factors include personal risks, behaviors, family structure, and occupational and environmental influences. According to the article, EHRs should move beyond documentation to interpreting and tracking information over time.
The article was prepared collaboratively with the American Academy of Family Physicians, American Academy of Pediatrics, American Board of Family Medicine and North American Primary Care Research Group. It is endorsed as a national policy statement that defines necessary additions to EHR functionality to better support the needs of primary care and patient-centered care.
"Primary care is vital to good health. This is demonstrated by evidence that primary care extends lifespan, reduces morbidity, increases satisfaction, reduces disparities and is cost effective. It's also where the majority of people receive care," said Krist, who is the co-director of the Community Engagement Core within the VCU Center for Clinical and Translational Research. "EHRs with greater functionality can move primary care towards more personalization of whole-person care with active patient and care team participation."
Person-centered care requires integration of social, cultural and community context; biomedical, behavioral and social risks; and personal goals and preferences. The article recommends that a person-centered summary, or "patient profile," should be available as a dashboard in the EHR and decision-support tools should be tailored on the basis of these factors.
Other high priority EHR enhancements cited in the article include:
- Enhancing the extraction, interpretation and prioritization of critical health information for individual patients and a clinician's patient panel
- Advancing information exchange to coordinate care across clinicians and settings
- Greater patient engagement
- Population-management tools to deliver care
- Reduction in documentation burden
- Better integration of care across settings
"By enhancing electronic health records and creating a more person-centered health care model, primary care physicians and their patients can more effectively partner to improve health and well-being," Krist said.
"Electronic health record functionality needed to better support primary care." Alex H Krist, John W Beasley, Jesse C Crosson, David C Kibbe, Michael S Klinkman, Christoph U Lehmann, Chester H Fox, Jason M Mitchell, James W Mold, Wilson D Pace, Kevin A Peterson, Robert L Phillips, Robert Post, Jon Puro, Michael Raddock, Ray Simkus, Steven E Waldren. J Am Med Inform Assoc. Published Online First: 15 January 2014 DOI: 10.1136/amiajnl-2013-002229