The electronic medical record and Patient-centered care

One goal in EMR development should be to facilitate a patient-centered clinical encounter. Much prior EMR development has focused on capturing objective data, such as laboratory values and medication lists. Less attention has been devoted to the more complex task of capturing and analyzing data that incorporates the patient's concerns and preferences.

A literature search supplemented the author's own various experiences with one EMR (that used nationally by the Department of Veterans Affairs) from his various perspectives of a physician, an educator, and a Chief of Staff. This data was used to identify both opportunities and obstacles to promoting patient-centered care in an integrated care setting that relies heavily on an EMR. Qualitative analysis and suggestions are offered for how the EMR can individualize patient care, in support of a patient-centered approach.

Three promising target areas in efforts to develop a patient-centered EMR are: elicitation of the chief complaint, conduct of health screening activities, and evaluation of health literacy. A range of strategies were identified, some of which may require information technology development, such as to facilitate patient direct entry of data into their own EMR.

EMR design can facilitate a more patient-centered clinical encounter. Beyond the benefits to the individual patient, patient-centric modifications to the EMR architecture may also facilitate quality improvement and research activities on patient centered care. In light of the widespread current discussions of a movement toward Accountable Care Organizations that use EMR, it will be especially important to ensure that the resulting care systems maintain a focus on the patient and not just on the system of care.