The Electronic Health Record

Electronic health records (EHRs) designed for large health systems have a broad number of components compared to the ambulatory EHRs that support primary care and outpatient specialty care systems. Ambulatory EHRs were designed around office practices to electronically capture data collectedor generated in the office. EHRs organize laboratory results, medications prescribed, problem lists, and documents useful to health care professionals’ outpatient care. EHRs often interface with practice management systems. EHRs are designed as “transactional” databases, similar to a bank deposit transaction, initiated with a patient encounter and completed when the progress note is signed and the chart is closed. While good for a single office encounter, this architectural design of EHRs creates limitations in what it can provide to support effective chronic care delivery. Therefore, the data warehouse and registries are also needed for robust population outcomes improvement.

Advanced technology enables decision support. Certified EHRs are now required toprovide basic decision support, such as reports of potential adverse drug-to-drug interactions and drug allergies. More advanced decision support software tools analyze more complex tasks, providing advice based on evidence-based guidelines and decision trees. Decision support can assist both the health care team and the patient, and it can range from simple reminders for preventive health screening or periodic lab testing to supporting complex individual patient decisions with insulin adjustment or multiple drug use. Newer systems use artificial intelligence to refine the decision support down to the individual patient level. Advanced decision support needs to be linked to a comprehensive clinical data warehouse.1

Embedding evidence-based guidelines allows automatic testing of compliance. If non-compliance is discovered, point-of-care reminders or other tools can advise steps for corrective action. Educational tools can be linked to that event to facilitate the health care professional’s re-education.

Finally, although the EHR provides common data to all team members, it was designed predominately for physicians. However, it is also necessary to present actionable data to community health workers, peer educators, and others on the team.

Learn more about how EHRs can support population management.

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