Electronic Health Records - Transform - Center of Innovation - Mayo

Direct Primary Care Requires a New Paradigm for Electronic Health Records

Post Written By Kat Quinn

The answer is a problem-oriented approach.

The growth of Direct Primary Care (DPC) is irrefutable and unprecedented. More and more primary care physicians are choosing to drop third-party health insurance and embrace this new model of medical practice based on direct financial relationships with patients and employers.

The goals for most DPC physicians are to see fewer patients each day; to spend more time with patients during visits; and to focus on the delivery of comprehensive high-quality preventative care.

Unfortunately, the vast majority of Electronic Health Record (EHR) systems are not designed to support DPC due to major deficits in clinical documentation. Fortunately, these shortfalls can be solved in ways that actually enhance productivity and professional satisfaction.

Clinical Documentation – What’s the problem?

According to new research by the American Academy of Family Physicians (AAFP), “Patient encounters in primary care are nonlinear and unpredictable and have for years been misunderstood by systems designers charged with making practices more efficient.” (1)

One major issue is that both doctors and patients think in problems, but EHRs do not organize
information or workflow according to problems. Instead, patient health data is organized by its source.

For example, all of a patient’s lab results are listed together, regardless of the problems for which they were ordered. The same source-based organizing principle is used for medications, exam notes, orders, referrals, etc.

Cognitive Overload

When confronted with patients having multiple complex problems, physicians too often feel like they are drowning in an ocean of disorganized patient data. Let’s do the math to see why.

A primary care provider seeing a patient with three active problems must mentally juggle an average of twenty individual datum—such as drugs, lab orders, and subjective observations during the visit. If the physician sees 15 patients per day, she is handling more than 300 critically important pieces of information.

Miller’s Law(2) states that the number of objects an average human can hold in working memory is 7 ± 2, or a maximum of nine. The workload calculated above stretches the limits of a physician’s multitasking capacity. This leads to cognitive overload and can impair the medical decision-making process, leading to misdiagnosis, drug errors, and other potentially life-threatening mistakes.

Problems Give The Answer

The answer is a problem-oriented approach to organizing information and workflow. All notes,
medications, labs, orders, referrals, etc. are associated with specific patient problems. The problem list provides a “table of contents” to the specific issues that are clinically relevant.

This intuitive interface makes it easier for the physician and patient to set the agenda for the visit, and move from problem to problem as they interact during the visit.

Another advantage of a problem-based workflow is its ability to accommodate the nonlinear nature of an office visit. You can set your agenda, start working problems, and then add additional problems or refine problem to a more specific one.

Thinking In Problems Improves Decisions

The problem-oriented EHR is ideal for Direct Primary Care because most encounters are characterized by multiple problems, which is different from a specialist, who typically sees a patient for a single problem during any given visit. Additionally, DPC medicine has a more holistic approach to patient health that neatly aligns with the problem-oriented medical record, which provides a longitudinal view of the patient’s health care over time.

Perhaps most importantly, an EHR with the patient problem list as its organizing principle can help reduce cognitive overload in the exam room. Physicians can now see “bits” of data – like lab results – associated with a specific problem(s), easing the number of mental connections required to make a sound medical decision.

Pri-Med InLight EHR – Designed for Direct Primary Care

Now there’s a new cloud-based EHR system specifically designed for Direct Primary Care providers: Pri-Med InLight EHR. With a problem-oriented approach to information organization and workflow, InLight EHR actually “thinks” like a doctor. Its intuitive method for organizing clinical records and practice workflows makes InLight EHR fast, easy, and satisfying to use.

Based on technology first created by physicians at Massachusetts General Hospital, and later refined by developers at Amazing Charts, a leader in highly usable EHR systems, InLight EHR is now available from Pri-Med, a leader in professional medical education. For more information, visit www.inlightehr.com.

About The Author:
Kat Quinn, MBA is a digital health start-up specialist with a focus in HealthIT and Direct Primary Care (DPC) start-ups and co-founder of SheepGuru.com, one of social media's leading DPC voices. She holds an MBA in Health Informatics and a BS in Marketing. Her primary objective is to help launch digital health start-ups and Direct Care practices. Her passion is health and wellness, and she is an advocate for free-market health care.

References:
(1) AAFP - http://www.aafp.org/news/practice-professional-issues/20150915workflow.html

(2) Wikipedia - https://en.wikipedia.org/wiki/The_Magical_Number_Seven,_Plus_or_Minus_Two

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