Electronic health records are poorly designed to support longitudinal, personalized healthcare and must be reconfigured around patients’ life and health goals, providing clinicians with relevant and actionable information that is responsive to patient needs.

So argues Zsolt Nagykaldi, associate professor and director of research in the Department of Family and Preventive Medicine at the University of Oklahoma Health Sciences Center, and an international team of primary care researchers.

Writing in the latest issue of the Annals of Family Medicine, Nagykaldi and his colleagues contend that most existing EHR systems were “designed in the prevailing disease- and payment-focused care paradigm that often loses sight of the goals, needs and values of patients and clinicians.”

The special report provides a blueprint for what they call “goal-directed” EHRs based on patient life and health goals to help guide clinicians in co-creating personalized care plans that better serve their patients.

“When you take a look at how healthcare is delivered today and how electronic health records have been designed, you see this great gap between what patients are getting and what they really need,” says Nagykaldi. “Our healthcare system focuses on individual diseases rather than overall health and oftentimes puts the achievement of goals of the clinicians ahead of what the patients really need to achieve longitudinally in their lives.”

Zsolt Nagykaldi
Zsolt Nagykaldi

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According to Nagykaldi, clinicians are not currently able to include the “fullness of the patient narrative” in EHRs in a way that is actionable.

To create goal-directed EHR systems, he and his co-authors recommend including core patient profile and health planner functions into existing EHRs and establishing linkages between patient characteristics and other parts of the record.

In addition, they make the case that patient attributes captured by EHRs as structured data—because free-text notes are difficult to operationalize—must be expanded to include actionable socio-cultural and socio-economic information, life and health goals, care preferences, as well as personal risk factors.

“Once the attributes are captured as structured data, they can be leveraged by other EHR components to help patients and clinicians co-construct personalized care,” conclude the authors. “To accomplish this, a new taxonomy for personal health attributes needs to be developed that incorporates categories of patient goals (those related to life extension, health-related quality of life, physical functioning, human development, end of life, and healthcare relationships). These attributes will then need to be linked to evidence-based strategies that can promote the achievement of patient goals.”

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