Page 13 - Volume 69 Number 3
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making any kind of meaningful entry into the electronic health record. (They are allowed to verify some aspects of the history in an outpatient visit, however they cannot record a history of present illness.) Gone are the days when students learned
to do meaningful things like writing orders and entering notes into the chart, under supervision,
as part of the learning experience.
Improving health care delivery and outcomes, and achieving improvements in overall health status has always been a formidable challenge. As with all such challenges, there is more than one school of thought as to how best to proceed. In this case, CMS and large health care systems have adopted (or acceded to) a top-down approach in which broad goals are set by policy-makers at the top, based on the global considerations most important to them, such as costs associated with treatment of a given disease. They are trying to achieve these goals by imposing “incentives” through the medium of the electronic health record. The EHR in this scenario becomes the avatar of big data and, as such, a pariah in the medical community.
There is an alternative approach, namely to work from the bottom up, incrementally, on the problems of health care delivery facing the physician at the local level. This approach uses the EHR as a medium, but works on local, recognizably relevant issues and is therefore much more likely to achieve better buy-in to the extent that the EHR helps the individual physician do his or her job.
The EHR is here to stay. We need to find better and more meaningful ways to use it. I cannot envision that the powers that be, although they will continue to modify their present approach, will abandon it for the alternative one described above. Local efforts to achieve, not to mention improve, quality of care have been made more difficult by the inflexibility and time-consuming burden that has come with the size of the current EHR platforms. Let’s hope it does not extinguish them altogether
Volume 69 • Number 3

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