AMDIS: EHRs need to address care coordination needs of elderly

Twitter icon
Facebook icon
LinkedIn icon
e-mail icon
Google icon
 - Doctor and patient

BOSTON—The next several years will be dominated by huge implementation challenges, said Charles Safran, MD, MS, chief of the division of clinical informatics at Harvard Medical Faculty Physicians, speaking at the AMDIS Fall Symposium.

Innovation is necessary, however, because in this new era we’re more focused on the EHR as real-time patient-centered records that make information available anywhere anytime, he said.

Safran has been working on InfoSage—information sharing across generations--a five-year project funded by the Agency for Healthcare Research & Quality. The consumerization of healthcare will lead to more and more patient-contributed data. “We don’t even remotely know how to deal with the quantity of data we’re about to see,” Safran said.

The InfoSage population has a median age of 83 and is a frail group. Aging creates healthcare decision making, information management and communication challenges for elders and their families. “Care coordination is exceptionally challenging and respecting the elder’s preferences and priorities is often lost in translation,” he said.

Safran proposed the building of a living lab to identify the needs of elders and those helping to care for them. Goals include longitudinally studying elder and family collaborative interactions and information management, and evaluating the extent to which InfoSage improves communication, coordination and collaboration for elders and their families. “When an elder ages and we shorten the hospital length of stay, we increase the technical care burden on the home environment,” he said.

Learning from social media, “we know that we can build social networks around families. Think of this as a private Facebook for elders, their families and their formal and informal caregivers.” With his own aging parents, Safran said he was struck by how many resources are available in the community that he didn’t even know about. “As clinicians, we may not be attuned to some of the issues or resources available.”

Innovation is not only possible but necessary, Safran said, because EHRs don’t address care coordination and patient involvement. “No amount of grafting of technology on these systems are going to solve these problems. We have to build tools for families from a different perspective than clinicians’ because we’re not solving the families’ problems.” And with the onslaught of patient information, “we had better be partners in design. EHRs are too facility- and physician-centric to address the healthcare needs of the elderly. All of us are going to face the problem of being informal caregivers at some point.”

Most of today’s EHRs are based on code bases that were designed 10 or 20 years ago, Safran said. “Each one is a graft so what happens is you get these screens that are feature rich and function poor. We should be rethinking the collaborative environment and what [information systems] look like for a family and care network.”