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J Am Med Inform Assoc doi:10.1136/amiajnl-2013-002229
  • Perspective

Electronic health record functionality needed to better support primary care

  1. Steven E Waldren4
  1. 1Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA
  2. 2Department of Family Medicine and College of Industrial and Systems Engineering, University of Wisconsin, Madison, Wisconsin, USA
  3. 3Mathematica Policy Research, Princeton, New Jersey, USA
  4. 4Center for Health IT, American Academy of Family Physicians, Kansas City, Kansas, USA
  5. 5Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
  6. 6Departments of Pediatrics and Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, USA
  7. 7Department of Family Medicine, University at Buffalo, Buffalo, New York, USA
  8. 8Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  9. 9Department of Family Medicine, University of Colorado, Denver, Colorado, USA
  10. 10Department of Family Medicine, University of Minnesota, Minneapolis, Minnesota, USA
  11. 11American Board of Family Medicine, Washington, District of Columbia, USA
  12. 12Department of Family Medicine, Virtua Health, Voorhees, New Jersey, USA
  13. 13OCHIN, Portland, Oregon, USA
  14. 14Department of Family Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
  15. 15Brookswood Family Practice, Langley, British Columbia, Canada
  1. Correspondence to Dr Alex H Krist, PO Box 980251, Richmond VA 23298-0251, USA; ahkrist{at}vcu.edu
  • Received 30 July 2013
  • Revised 18 December 2013
  • Accepted 23 December 2013
  • Published Online First 15 January 2014

Abstract

Electronic health records (EHRs) must support primary care clinicians and patients, yet many clinicians remain dissatisfied with their system. This article presents a consensus statement about gaps in current EHR functionality and needed enhancements to support primary care. The Institute of Medicine primary care attributes were used to define needs and meaningful use (MU) objectives to define EHR functionality. Current objectives remain focused on disease rather than the whole person, ignoring factors such as personal risks, behaviors, family structure, and occupational and environmental influences. Primary care needs EHRs to move beyond documentation to interpreting and tracking information over time, as well as patient-partnering activities, support for team-based care, population-management tools that deliver care, and reduced documentation burden. While stage 3 MU's focus on outcomes is laudable, enhanced functionality is still needed, including EHR modifications, expanded use of patient portals, seamless integration with external applications, and advancement of national infrastructure and policies.

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