EHRs and the continuum of care, Part 1: the patient-specific knowledgebase.

Given Health Care Reform, the best core design element an exam record can been built around is that of a dynamic content-driven knowledgebase. The knowledgebase can handle continuous growth to encompass the ever-expanding body of medical knowledge and make it available at the point of care.

However, this is only one side of the knowledgebase concept.  The purpose of a health record is to create a patient-specific knowledgebase of relevant health information.  There is a clear role for the carry-through of knowledgebase concepts into the patient-specific data set.  Clinical decision trees structured on the input side allow us almost unlimited ability to present new and existing knowledge to the end user and, beyond presentation, provide clinical decision support.  Once selections on a particular patient are made, we have begun, effectively, to create this secondary knowledgebase, one that is specific to the patient. Much of the purpose of health care reform is to acknowledge the value of this patient-specific knowledgebase and create a health care delivery system that shares this information. Every provider involved in the care of the patient must have access to this knowledgebase.

If you’re already involved with EHRs you’ll be familiar with the Continuity of Care Document (CCD), which is really about sharing patient health information between providers. In the year ahead, you’ll hear a lot more about Health Information Exchanges (HIEs) at the state level. HIEs are all about expanding and coordinating the sharing of patient health information, en route to sharing not just at the state level but the national level.

Lest we get caught up in acronyms, here’s a salient point: it’s no longer good enough for EHRs just to record results; they must drive better results. The Health Care Reform term is “improving patient outcomes”.  Stage 1 certification doesn’t yet push hard on this standard. The level of clinical decision support required at stage 1 is very basic and, for many EHRs, is covered by the e-prescribing interface. Going forward, the bar will rise significantly and the value of a rules-based and content-driven knowledgebase approach will emerge.

Jim Grue, O.D.