By Megan Williams, contributing writer
A recent article in the Harvard Business Review has pointed to EHRs as the solution to achieving integrated care. An article for EHR Intelligence has responded though, with the charge that the answer is too simple and neglects some details in the real-world examples of EHR technology that are crucial in addressing the integrated care question.
Solutions providers will do well to pay attention to the dynamic between the two articles, as they reflect a disconnect between the perception and the reality of EHRs that you will need to navigate in dealing with your clients and users.
An Overly-Simple Solution?
The Harvard Business Review article starts with an anecdote about a healthy, 85-year old woman who broke her elbow, and after a series of disjointed care episodes, ends up dying with a fractured spine after a fall. Her family ended up serving as project managers for the entire episode (something that’s highlighted as happening with no training) and having to piece together all the parts of “Dottie’s” journey through the healthcare system.
The article goes on to suggest that if EHRs had been used in more comprehensive ways, Dottie’s experience could have been much different. It specifically lays out the following solutions to achieving integrated care:
- aligning payment with integrated care
- re-engineering processes
- creating universal EHRs
- moving away from specialists
- recognizing and respecting caregivers
- clarifying the journey
- minimizing disruption of the patient’s life
- aiming for health
Examples Falling Short
HBR highlights two specific examples from Kaiser Permanente and the VA, in the use of integrated EHR technology: “Kaiser Permanente has an EHR that is shared by primary care doctors and specialists who work in hospitals and offices and is also used by nurses, pharmacists, physical therapists, and nutritionists. Their ability to collaborate electronically with patients in their homes and with each other using tools such as electronic consultation has fundamentally changed the way medicine is practiced at KP.”
And: “Back in the 1990s, the U.S. Veterans Administration developed an electronic health record (EHR) that linked information across venues of care and provider specialties. This early work showed that linking clinicians electronically was transformational.”
EHR Intelligence points out that key aspects of the two systems have been left out of the HBR article. Kaiser is using an Epic EHR solution, featuring its own optimizations and enhancements. Kaiser’s solution is markedly more expensive than most solutions and has been found to not be producing the savings expected. Few organizations have access to the level of financial resources that Kaiser does.
The VA is still facing challenges around its system, from the Phoenix scheduling controversy, to Congress pushing it to modernize its platform, and better integrate with the Department Of Defense’s systems when they do integrate.
Read more about the American Medical Informatics Association’s (AMIA) take on the EHR of the future here.