This article presents a consensus statement about gaps in current electronic health record (EHR) functionality and needed enhancements to support primary care. Participating organizations are the American Academy of Family Physicians (AAFP), American Academy of Pediatrics, American Board of Family Medicine, and the North American Primary Care Research Group. NIAC member Steven E Waldren of the AAFP is among the authors.
Primary care attributes, established by The Institute of Medicine, were used to define needs and meaningful use (MU) objectives to define the functionality of the EHR. The authors indicate that current objectives “remain focused on disease rather than the whole person, ignoring factors such as personal risks, behaviors, family structure, and occupational and environmental influences.” They further state that “primary care needs EHRs to move beyond documentation to interpreting and tracking information over time, as well as patient-partnering activities, support for team-based care, population-management tools that deliver care, and reduced documentation burden.” The authors praise the stage 3 MU’s focus on outcomes, but contend that enhanced functionality is still needed. Among the things needed to accomplish this are:
- EHR modifications,
- expanded use of patient portals,
- seamless integration with external applications, and
- the advancement of national infrastructure and policies.
The important issue of patient-centered care is addressed, noting that an “understanding of the patient is critical to the establishment of long-term partnerships.” The consensus statement indicates that a patient profile should be available….in the EHR and that decision support tools should be tailored based on the factors therein. In addition, patients should be able to enter and edit their own information, which can improve accuracy and ease of data collection.
With regard to integration, clinicians need an effective EHR to serve as “the information backbone across all primary care attributes.” In addition, population-management tools are needed at the practice level. Because information and patient needs vary between providers, EHRs should allow “local tailoring of functionality and content while maintaining standardization.”
Additional information on this important consensus statement published by the Journal of the Medical Informatics Association may be found at: http://www.ncbi.nlm.nih.gov/pubmed/24431335 .