Meaningful reform of primary care should not only address the provision, documentation and payment of care; it should be based on patients' goals for their lives and health, with corresponding redesign of electronic health records. A report from an international team of primary care researchers recommends that the current problem-oriented fee-for-documentation structure of EHRs be replaced by a framework built around life and health goals. This focus would not only better serve patients; it would also help refocus medical professionals on the full scope of human health. To begin the process of creating goal-directed electronic health records, the authors suggest incorporating core patient profile and health planner functions into existing EHRs and creating linkages between patient characteristics and other parts of the EHR. If patient attributes captured by EHRs are expanded to include actionable sociocultural and socioeconomic information, life and health goals, care preferences, and personal risk factors, they can be leveraged by other EHR components so that patients and clinicians can work together to develop personalized care. The authors point out that, although numerous systemic and administrative health care innovations have been tried, the problem-oriented approach to care and its conceptual image coded into the medical record remain the same across innovations. If patient life and health goals are to drive health care and medical record design, shifts will also need to occur in health care delivery, measurement, and payment. The authors call for research into how patients and health care teams can partner effectively using goal-directed health records.
Moving From Problem-Oriented to Goal-Directed Health Records
Zsolt J. Nagykaldi, PhD, et al
University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma