The Trouble with EHRs
"This will cut off at the pass a lot of problems you could have if you don't do this," Chebeleu says. "Even if you invest one full-time equivalent, pilot it."
The move to a team-based effort to improve the quality of the medical record "flies a lot in the face of our traditional conception of the medical record as something that belongs to the doctor [and] belongs [only] to the health system," says Jeffrey Linder, MD, a general internist in the division of general medicine and primary care at the 800-bed Brigham and Women's Hospital, part of the seven-hospital Partners HealthCare system.
Until recently, Lindner served on the executive committee of the Longitudinal Medical Record, Brigham and Women's homegrown electronic medical record. Linder still serves on the adult primary care expert panel at the hospital and, like almost all Brigham physicians, has a faculty appointment at Harvard Medical School as an associate professor of medicine.
"It's a big shift to move from that to a more collaborative space where patients can enter data that's useful for their care, that their doctors want to see, but it's also curated and accepted into the record by some clinician," Linder says.
The big flood of nonphysician, nonclinician–entered data that Linder has anticipated for the past five years has yet to arrive, but he fully expects it.
Toward that end, Partners is creating a section in its EHR for patient-entered data. A clinician will need to review the entries and accept them into the chart, but those entries will remain labeled as patient-entered data. Data that is not accepted into the record will also remain, but "my impression is you'd really have to go looking for stuff that wasn't accepted into the record," Linder says.
At the same time that this is planned, Partners is in transition from LMR to Epic, due to be deployed across both inpatient and outpatient systems in 2015, Linder says. "The new healthcare landscape will challenge us to engage in population health management, improve the coordination of healthcare, and accept financial risk for the care of our patients. This new system will enable us to meet those challenges," Linder says. Between now and then, Partners will conduct due diligence to make sure that Epic's capabilities allow the kind of audit trail and other features it requires, he adds.
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