EXTREME MAKEOVER: EHR
It’s high time for an extreme Electronic Health Record makeover. That’s what Jonathan Nebeker, M.D., associate chief medical informatics officer for Veterans Health Administration, and cognitive psychologist Charlene Weir, Ph.D., R.N., believe. With a lack of information hierarchy in the current EHR, every data point is brought forward, which means that the pertinent details are often obscured. “We need to move from an electronic version of a two-dimensional paper document to a dynamic, interactive, 3-D chart,” says Weir. Together, they’re developing a graphical user interface that allows providers to manipulate information in a visual, almost tactile manner.
Nebeker explains that humans can only manipulate three to seven bits of data at a time, yet there are scores of active data elements needed for patient care. The evolved EHR is designed to provide faster and more accurate information while at the same time allow providers to explore different areas of data. In short, it supports both fast and slow thinking. It puts providers in control of the information they see, giving them both a high-level view of patient as well as the ability to zoom in on any detail they want to examine closer – like a lab value that’s out of standard range, for instance. “We need to allow for open-ended thinking even as we move toward standardization,” Weir explains. “Instead of trying to figure out what everyone needs, we should give people ways to play with data so they can use their expertise and highest level thinking to ask different questions and discover their own answers.”
Here’s what they’re imagining:
As a physician, imagine an EHR that arranged information to convey nearly everything you needed to know about a patient to make a diagnosis, prescribe treatment and map a mutually agreeable plan of care? An EHR that made clear which medications were related to which conditions, and updated you on clinical and patient goals. Imagine a user-friendly interface that provided a high-level view of the patient and the ability to zoom in on any detail. An EHR that didn’t require you to read or write long notes, but rather allowed you to annotate medications and observations with short but meaningful statements. No worries about entering information for billing, that will automatically happen later. Imagine an EHR that made it easy for you and your colleagues to work on a single plan of care to help the patient accomplish his or her goals.
As a patient, imagine if all your health care providers were creating a plan that addressed goals you care about. Whereas clinicians worry about vital signs and lab values, you want to wake up and feel rested or play nine holes of golf. What if the success of your care team was measured in terms of accomplishing those goals, all of it mapped out on your EHR with specific tasks assigned to each member, including you? Refill your meds, check. A go-to record designed to keep you on track.
