Current EHR Capabilities
Efforts up to this point have focused mainly on the most basic functional level of health IT, i.e., the development of EHRs for inputting, validating, storing and presenting basic patient data. Current EHRs also offer some decision-support through reminders and alerts (e.g., follow-up appointments, inoculations, and medication prescription checks), and may streamline certain workflows. While a necessary first step, much more is needed before EHRs can demonstrate the ability to foster significant improvements in healthcare quality, cost and safety.
Current EHR Deficiencies
EHR systems hold great promise in helping increase care value. Nevertheless, they have serious deficiencies that have not only weakened EHRs’ ability to help improve care, but have also led to widespread dissatisfaction among users. Despite the fact that “doctors are often prohibited from voicing specific concerns about a…system publicly” [reference], there are still many reports about their weaknesses, some of which are discussed below:
- Difficult to use and not interoperable. “The recent analysis was sharply critical of the commercial systems now in place, many of which are hard to use and do not allow doctors and patients to share medical information across systems” [reference]. “Providers continue to use workarounds to deal with perceived inadequacies of their electronic health records…such as difficulty in finding data and complex order entry processes” [reference].
- Fail to coordinate care and accommodate workflows. “Knowing all the different participants in the patient’s care team…and coordinating and integrating their electronic activities is what successful EHRs must handle with ease…Most existing EHRs…have…done a poor job [and] must...accommodate more fluid workflows that can change potentially daily or weekly based on the demands of new participants” [reference].
- Cause information overload. “EHRs often contain unnecessary or excessive information that "clutters the 'big picture' of patient care" and increases risk to patients…often you can't see the forest for the trees” [reference].
- Immature clinical decision support. “[T]he first generation of CDS [Clinical Decision Support] tools…in…EHR systems, has not lived up to expectations…[They cause] alert fatigue and [fail to] optimize [clinical]workflows” [reference]. “[F]uture generations of CDS tools will…be more tailored to both patients and physicians” [reference]. “[Additional R&D] is recommended…to bridge the gap between the promise and realization of [guided personalized medicine]” [reference].
- Does poor job with patient education and shared decision-making. “…health education materials delivered by EHRs are ‘rarely…understandable and actionable for patients’ who have low health literacy” [reference]. “Implementing shared decision-making isn't as easy as it sounds…the IT systems used…lacked capabilities to flag patients as candidates for decision aids or to track patients through the process” [reference].