EHRs must support two distinct types of care, Partners CIO says

Ever notice how so many examples of how EHRs can improve care focus on diabetes? That's because diabetes care has many clear protocols, copious amounts of scientific evidence that gets included in clinical decision support and clear quality measures.

But not all care is like diabetes care, as Partners HealthCare System CIO John Glaser notes in Hospitals & Health Networks. "The outcomes of a stroke are variable and difficult to measure. There are often no crisp guidelines for treating the fragile, elderly patients with multiple chronic diseases. And it would be a challenge to adequately structure the documentation of the clinician's thought process for a patient with a rare disease that is eluding diagnosis," Glaser writes in one of his regular columns for the magazine.

According to Glaser, healthcare can be broken down into iterative care--making diagnoses--and sequential care, which involves following widely accepted patterns of treatment. "The EHR must accommodate this diversity within an organization as well as for an individual clinician (a clinician may see this diversity daily) and for a patient (any patient may move from iterative care to sequential care and back again)," he writes.

From an IT perspective, each type of care calls for different types process re-engineering. "While there is a core set of EHR capabilities in both classes, the needs are different. Structured documentation may not be helpful for iterative care patients. Collaboration tools may be little help for patients with straightforward, acute conditions. Introducing EHR tools that are relevant in one class into the other class may interfere with rather than assist in the delivery of care," Glaser explains.

"If we introduce systems and implementations designed for one class into the other class, it is assured that the EHR won't fit the workflow or support the way we think."

To learn more:
- read Glaser's article in Hospitals & Health Networks