"We're very interested in having patients enter their own blood sugars and blood pressures and having some mechanism of allowing them to," Linder says. "The only mechanism right now for them to correct their data is via messaging. If they notice a problem that they disagree with, currently it's not really a collaborative space, where the practice and the patient are jointly curating the information in the medical record."
Like the other providers, Partners faces its own governance challenges during this transition. "The other cultural problem we're running up against that we're going to have to work our way through over the next decade is our conception of medical care—the unit of medical care," Linder says. "Right now I work in the ambulatory setting, so we're very focused on visits still, and hospitals are very focused on hospitalization, and so the record is designed around discrete events like that."
Thus, documentation of a medical record today remains largely the story of what was done at a particular visit. "Hopefully we're moving toward a health system that's focused on taking good care of you, whether or not you happen to be in the office at that moment," Linder says. "That shifts the value from visit-based data to the latest instance of the electronic health record as the truth, and that can happen at any time. It's not dependent on a visit."
Of all the stakeholders in healthcare, the ones most concerned about how the medical record evolves are probably the health systems' attorneys. "It's our lawyers who are most interested about keeping a record of everything that happens," Linder says. "Our health information systems department is very focused on keeping a record this way."
Even now, LMR records have a "history" button next to many coded elements, Linder says. "You can kind of delve into the history and see who updated it, and how and when," he says. "But if you think about all the moving pieces in an electronic health record, every single one of those elements has some mechanism for capturing histories behind that element, and it's a lot of data that nobody really has the time or inclination to go through, so it's challenging. It's definitely challenging."
This article appears in the December issue of HealthLeaders magazine.