Commentary: Current EHRs are building blocks for the future

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While some providers, no doubt, are frustrated with the current state of electronic health records, optimism lies ahead, according to James Cimino, M.D., chief of Laboratory for Informatics Development at the National Institutes of Health Clinical Center in Bethesda, Md.

In a commentary published this week in the Journal of the American Medical Association, Cimino calls today's EHRs a starting point on the road to more robust systems.

"Clinicians should recognize that current EHRs are illuminating the opportunities for the next generation of systems that will support clinicians as active partners across the spectrum of healthcare settings and tasks," he writes.

Cimino says that part of the problem with today's EHRs is that a good portion of such systems are built based on a billing system blueprint that simply "tacks on" clinical data functionality.

"Clinical documentation functions were a similar afterthought, added more in support of billing than patient care," he says. "This becomes evident when an EHR prompts the physician to specify which encounter he or she is interested in before providing access to a patient's data [rather than simply providing access to the entire longitudinal record, or provides prompts that relate more to documenting the level of service than what is most clinically relevant."

However, Cimino says, documentation process improvements currently being implemented into some systems show "promise" as being more than just data entry tools. "If impressions and plans can be captured within EHRs as explicit data elements, using standard terminology rather than being buried in the narrative text of a note, clinicians could use this information to better support clinical workflow," he says.

A recent Black Book Rankings survey predicted that 2013 would be the "Year of the Great EHR Vendor Switch," with up to 17 percent of physician practices planning to ditch their current EHR system.

The average physician lost nearly $44,000 over five years of implementing an EHR, according to recent research published in Health Affairs. Just 27 percent of physicians in that study achieved a five-year positive return on investment and only 14 percent more would come out ahead if Meaningful Use payments were factored in.

To learn more:
- read the JAMA commentary (subscription required)

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