ELECTRONIC HEALTH RECORDS IN ACADEMIC FAMILY MEDICINE PRACTICES: A TALE OF PROGRESS AND OPPORTUNITY

Elizabeth Baxley; Thomas Campbell

doi:10.1370/afm.807

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A missing link
Larry B. Mauksch

Published on: 14 March 2008

Published on: (14 March 2008)
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A missing link
Larry B. Mauksch, Seattle, USA
Drs. Baxley and Campbell,
Thank you for this survey of EHR use. It is fascinating to follow the influx of EHRs into medical practice and into academic settings. While the EHR holds great potential to improve quality of care, one important element is often omitted in implementation and assessment. The addition of new practice roles are probably necessary to sustain regular, effective use of the EHR for qu...
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Drs. Baxley and Campbell,
Thank you for this survey of EHR use. It is fascinating to follow the influx of EHRs into medical practice and into academic settings. While the EHR holds great potential to improve quality of care, one important element is often omitted in implementation and assessment. The addition of new practice roles are probably necessary to sustain regular, effective use of the EHR for quality improvement (your 4th paragraph). It is not surprising that this area is less developed in your findings.
New roles--probably some combination of care management, education, support, behavior change, and coordination-- will only exist with new funding mechanisms. These new roles may do more than help improve quality of care, e.g., registry management. They may absorb some of the additional work load that affects the already over burdened primary care provider. Two recent articles by Tom Bodenheimer, MD 1,2, address this issue.
In frequent discussions with medical students working in community practices with EHRs, I hear more skepticism and concern than optimism. The preceptors are tired, hurried and not supported. This is not the image we want at a time when attracting students to family medicine is so important.
A medical home does not an EHR make. Like many other things in the culture of medicine we are easily attracted to elements that offer concrete solutions to vexing, complicated problems. We feel the illusion of control. But system capacity needs to grow in concert. For the medical home to become a successful and lasting design, primary care must move from an individual delivery process to true team function.
As medical home experiments continue perhaps we will learn about sequential or developmental phases. It is not clear yet where the various features of EHR implementation are on this developmental track. I suspect that it is possible to implement some EHR parts too early.
1. Bodenheimer T. Coordinating care--a perilous journey through the health care system. N Engl J Med. Mar 6 2008;358(10):1064-1071. 2. Bodenheimer T, Laing BY. The teamlet model of primary care. Ann Fam Med. Sep-Oct 2007;5(5):457-461.
Competing interests: None declared
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Competing Interests: None declared.