Three hours into writing this week’s blog, I realized I had written myself into a deep hole. I was attempting to make the argument that if we are to evolve from existing EHR technology to a grand and glorious “EHR of the Future”, we must introduce some new and important requirements and capabilities. My problem is that the post had grown to over a thousand words, and I had yet to get to my main point. That is not going to work. So I am starting over. Here is my message, minus all of the background, explanation, pontification, and puffery.
We need a new and better Electronic Health Record.
It is tempting to call the EHR that I want for myself and for my family (you can use it too, if you want) the Lifetime Longitudinal Electronic Health and Wellness Plan and Record. Ok. So I can agree that this name does not yield to our habit of making everything in healthcare an acronym. LLEHWPR just doesn’t roll off the tongue. So, for simplicity sake, I am going to call it My Better EHR – and I will speak to the missing L, L, W and P. Those components are key!
What does My Better EHR do, or do better, than current EHRs - at least the ones I have used?
My Better EHR provides a perspective that is birth to death – call it lifetime and longitudinal. As a provider or a patient I may need to focus on a narrower time window to meet an immediate need but I want each and every episode of care and wellness planning session to be based on full knowledge and context of the past, present, and future.
My Better EHR is exceedingly granular. It contains every important health and wellness transaction, observation, value, event, and intervention. All notes, all labs, all images, all data. Taking this point to the logical and appropriate extreme, my Better EHR contains my DNA sequence. However, my family doctor won’t have to thumb through it to find out whether my elevated LFTs might be related to statin use. Store it all, show me what I need now and “blur” (don’t hide) the detail if that detail only confuses and confounds the immediate goal, whatever it might be.
My Better EHR is comprehensive. It can collect and, when necessary and appropriate, communicate, convey, and incorporate into health care and wellness planning the full context of my cultural, social, educational, environmental, philosophical, and spiritual background, choices, and preferences. That was a mouthful. Read it a couple of times – I had to.
My Better EHR fundamentally understands time, direction, velocity, and acceleration. Providers and patients alike need and want to know not only current status, but also the direction, magnitude, velocity, and acceleration of change – is XYZ getting better or worse and how rapidly? Change and acceleration are critical to effective health and healthcare decision-making.
My Better EHR provides role-based security and privacy features that give patients the ability to understand and implement policies to assure the right information is quickly accessible at the right time, to the right users. My Better EHR manages viewing and modifying information in a way that addresses the complex intersection of roles and responsibilities with care needs, circumstances and patient-choice.
Core to the use and utility of My Better EHR is that it addresses not just health, but also wellness. Health is, for better or worse, incontrovertibly tied to our concepts of injury and disease. Wellness addresses a richer, more personal, and more diverse concept. The constellation of life choices and pursuits that constitute an individual sense of wellness significantly extends the My Better EHR dataset. We must measure, monitor, and plan to this expanded view of what it means to the individual to be healthy and well.
Finally, and most importantly My Better EHR is about planning. My Better EHR is certainly an accessible ledger or chronicle of what was and is, as vetted by the patient and providers. But more importantly it facilitates and encourages the development and implementation of a plan to achieve each person’s self-described ideal state. My Better EHR allows all stakeholders to participate in taking inventory of resources, developing an explicit, realistic, aggressive set of goals, and acting as the “playbook” - communicating and coordinating all efforts to achieve the individual’s goals.
The concept of My Better EHR as a vehicle for improving health and wellness is founded on two key beliefs. The first is that every individual, to the extent possible, seeks to make and implement decisions that Promote Wellness, Maintain Health, and Restore health and wellness when the first two strategies fail. We all want to feel good about our life and our life-choices and we all need help implementing our plans. The second foundational belief is that EHRs that are carefully and capably crafted can promote rapid achievement of health and wellness goals and optimize individual and population health.
Understand, this description of My Better EHR is not simply a thought experiment. Rather, it is a roadmap for growing and expanding ChartPath, Our Better EHR.