EMRs and Care Coordination: Square Peg vs. Round Hole?

Posted by Gary Winzenread

October 13, 2015 at 4:39 PM

“Can we do care coordination with our EMR?”

It’s a question I’m hearing more often these days, as the need and business case for care coordination becomes clearer. And it’s not altogether surprising that many hospitals and healthcare organizations want to use their multi-million-dollars EMR systems for as many tasks as they can. But, as I highlighted in a recent post, care coordination isn’t necessarily the purpose or point of EMRs.

In most cases, EHRs are not flexible or configurable enough. Consider the AMA’s EHR usability framework, which lays out eight ideas for improving EHRs, including their need to “promote care coordination.” For instance, the AMA recognizes that:

“Transitioning patient care can be a challenge without full EHR interoperability and robust tracking. EHR systems need to automatically track referrals, consultations, orders and labs so physicians easily can follow the patient’s progression throughout their care.”

Currently, EHRs don’t do any of these things well, if at all.

Another issue is that EHRs aren’t configurable enough to support unique and specific workflows and protocols established by hospitals.

Few EHR systems are built to accommodate physicians’ practice patterns and work flows, which vary depending on size, specialty and setting. Making EHR systems more modular would allow physicians to configure their health IT environment to best suit their work flows and patient populations.

We couldn’t agree more enthusiastically with the AMA’s recommendations. The underlying assessment that current EHRs simply don’t have these capabilities today also confirms our experience. Again, it’s not what these systems were designed to do. They were designed to function as the single, centralized repositories of capturing data for each patient interaction and for clinical decision support. But today’s healthcare reality is increasingly fragmented, with multi-specialty, multi-facility care delivery. And not every person or entity is involved in delivering care can (or should) use EHRs.

As such, EHRs look more like outdated “big iron” systems of a bygone computing era. With underlying technology and structures that were first designed in the 1980s, they are engineered more like mainframes than the lighter-weight apps that now dominate computing. So, returning to the main question, in our view, EHRs have a role to play in care coordination, but other specialized tools (interoperable with EHRs) are necessary to do it properly.

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