• Jaiwant Mulik

Coherent Health Records: Evolution of EHRs

It is with great interest that I have been reading about Epic systems founder and CEO Judy Faulkner's suggestions of moving to from current EHRs to Comprehensive Health Records (CHR). The idea of CHR's is that they include more than patient health records, in particular they include "social determinants" that influence a patients health.

It is unclear to me if this is mostly an attempt to create another buzzword or a serious change in how the healthcare industry might address patient health. My best guess is that this change has elements of both. The questions to ask then are: Who is driving the change? What is in it for them?

Physicians already include social determinants (among other such as economic and behavioral) in their assessment and treatment of patients. Physicians assess if such factors should or should not have an effect on treatment. Using a "CHR" then is an attempt to legally record factors that may or may not be related to a patient's health. At least once a year my doctor makes me fill out a paper form trying to determine if I am suicidal (I am not, thank you for your concern).

So then why this change? The magic words, in my mind, is "value-based medicine" the idea that physicians would get paid based on the quality of their treatment rather than the quantity of treatment. So, anything that anyone (EHR vendors included) can do to convince a physician that a system/feature/add-on will help with value-based medicine is attractive to physicians. But is it? EHR's vendors are would love to say that it is, after all once you use the word "comprehensive", it should be clear at the system is "comprehensive". If you have a comprehensive view of patients how can that not be a good thing?

Given the current dismal state of affairs in getting a coherent view of medical records it sounds far reaching to aim for comprehensive. First coherent then comprehensive. I would suggest let's aim for "Coherent Health Records" first. The original goal of EHRs.

But then again, the job of a CEO is to be a visionary who can execute. The vision part of CHRs is ambitious and ideal, the devil is in the execution.


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