Episode Details

So, a few things to remind everybody. First of all, don't forget EHRs (electronic health records) were purpose built originally for billing. This is no secret. People quite openly have called EHR systems glorified cash registers. If I want to be generous, maybe I would restate this to say that EHRs were designed to document patient interactions. This is what their core architecture was built to achieve.

But today, there's a lot that goes on that isn't a traditional patient interaction. First of all, me even calling it, frankly, a patient interaction should give longtime listeners a clue where this is headed. I mean, say you're sitting at home on your couch. I don't know. You're probably not considering yourself a patient. You're considering yourself a person sitting on your couch.

However, say you're sitting on your couch and you haven't taken your COPD maintenance therapy. Potentially that is something of clinical significance that maybe should get figured out and noted somewhere—potentially prior to the acute event going down.

Or, still talking about things that are relevant to patient health but which don't naturally tuck into an EHR system's native architecture, maybe we have social workers and nutritionists and all kinds of people who are not doctors or nurses or PAs (physician assistants) in this mix. Most of the time, these people don't even have access to the EHR. I mean, what percentage of things that are going to impact a person's health outcomes can be classified as traditional patient encounters that EHRs were designed to document? I mean, you've got your scheduler who wants to tell the transportation company something about a patient. Anything RPM. Where's the caregiver or the family in that garden-variety patient interaction?

In sum, what is happening between codes getting written in patient health records? Where's all that information going? I mean, what order set are you gonna use to get all that in and out of the system?

Am I saying anything revolutionary that many of you don't already know extremely well? No, I am not. But I am shining the spotlight on it to challenge what might have become a sort of default position at provider organizations today, which is to make the EHR the one ring to rule them all, which might be something to consider revising strategically.

My guest in this healthcare podcast, Emily Kagan Trenchard, makes a super point about all of this that I haven't heard made so succinctly or so eloquently. Emily puts it this way: She says just integrating into the EHR as a reflex without contemplation is kind of the olden days. She talks about identifying the core functionalities, the centers of gravity that are needed to bring together providers and patients and everybody else in the mix. Then you find the best systems—call them platforms if you want. But if, at a fundamental level, you have a technology designed for one thing and you're trying to shoehorn it to do something else and this something else is a critical business function, maybe this is something to think about at the highest levels.

Of course, it goes without saying that these platforms have to work together (obviously); but you kind of gotta get the right platform for the right job.

Now, to make one point clear as glass, what we are not talking about here is cobbling together a bunch of point solutions. What we are talking about is getting the fundamentals, the core architecture here, solidified. Pam Arora talks about this at length in episode 246. She's the CIO at Texas Children's. Pam Arora says that if a health system doesn't get its technology infrastructure rock solid, if that infrastructure is janky in any way, then everything built on top of it will require duct tape and workarounds and probably not go as well as planned.

On the show today, Emily Kagan Trenchar