Beyond the EHR: Putting Patients First

November 20, 2015

How can electronic health records (EHRs) be used so that technology isat the service of providers and patients? To achieve true meaningful use, perhaps we need to look beyond the EHR.


Overlay software has become a key term in the search for meaningful use. It strives to create—and extract useful meaning from—huge volumes of EHR data. Still, all of the patient-centric information it produces considers its subject to be passive. These are orders for a patient, results from tests performed on a patient, documentation about a patient. The technologies focus on clinician benefits. Patient perspectives, needs, challenges, and preferences are not a primary consideration.

Why Patient Engagement Matters

Passive patients are no longer an option for three reasons:

  1. Today’s biggest medical challenges are related to chronic disease and its associated economic impact. They have largely become a matter of age and lifestyle choices. Our decisions and actions can improve or even reverse the effects of chronic diseases like diabetes and heart disease. That makes patients primary decision makers within the care team.
  2. The shift from volume- to value-based reimbursement demands that the way we work with patients must change. It incentivizes providers to focus on health rather than procedures and interventions. That change means moving from episodic, interventional care to proactive, connected care that ensures efficient use of resources to optimize outcomes.
  3. Technology and information transparency have changed consumer expectations. “There’s an app for that” in every facet of our lives, whether it’s dinner, transportation, products, or services. As consumers, we have transparent information at our fingertips and expect to leverage it to make the best decisions. We expect an accurate diagnosis, as well as clinical best practice in treatment. But we also expect more: better access, greater convenience, better communication, and better support tools.

The Population Health Conundrum

The new language of population health, however, often assumes the same outdated view of a passive patient: care management, patient adherence, non-compliance, patient monitoring. But patients are more than their diagnoses. That’s why patient transparency—and how clinicians understand, respond to, and use that information—represents the real frontier in population health and wellness:

  • How do patients spend their time?
  • What are their goals?
  • What obstacles do they experience in achieving those goals?
  • How do they access information?
  • Whom do they trust and listen to?
  • How are they motivated?

These questions move us away from a view of the patient as a collection of test results and care plans. Instead, we view the patient as a person with complex needs, concerns, activities, choices, and motivations.

The Consumer Information Age

Digital information about individuals is everywhere—their activities, preferences, relationships, influences, and decision-making processes. It’s a record of individual concerns, goals, and behavior. Organizations constantly analyze this universe of data to build consumer relationships.

As complex as healthcare has become, we can now return to the importance of the human factor in care. Relationships and individual patient communications represent the re-emergence of a more basic care model empowered by a completely new set of information and technologies.

Perhaps the most meaningful use of healthcare information technology is how we can manage information, content, and communication to create and build the patient experience. Like the EHR, this information must be organized in useful representations around the patient. Unlike the EHR, its focus and purpose is not what we do to or for the patient, but how we relate to, talk to, listen to, and influence the patient.

We cannot make hard choices and changes for our patients, nor can we make them despite our patients. Health change will only happen with our patients.

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