Making the Case for a Problem-Oriented EHR

Long before EHRs were in existence, John Goodson, a primary-care internal medicine physician, worked with a team of developers at Massachusetts General Hospital (MGH) to create the methodology that would become the basis for a problem-oriented EHR, Pri-Med InLight™, co-developed by Pri-Med and Amazing Charts. Goodson, whose medical career has spanned over 30 years, is also an associate professor of medicine at Harvard Medical School, and has always had a special interest in the application of technology to medicine.

While the development and use of EHRs has revolutionized medicine, the technology is still in its infancy. Many physicians are frustrated with software interfaces that are difficult to use and time consuming. Many have characterized EHRs as simple databases, storing patient data but unable to make use of it in a meaningful way.

Physicians Practice recently spoke with Goodson, a consulting physician for Pri-Med/Amazing Charts, about the advantages of using a problem-oriented EHR, one he feels is more intuitive and useful than traditional EHRs.

Physicians Practice: How is a problem-oriented EHR different?

John Goodson: … The organization of the medical information in the medical record [is] chaotic. It [isn't] organized for the care of patients. [Pri-Med] recognized the potential benefits of organizing information in the medical record by the problems as they are defined by the clinical staff. A problem could be defined as something specific like high blood pressure, or something that is fairly nonspecific like abdominal pain.

[Our] premise was, when you as a clinician are done with seeing a patient, the first thing you do is say, "What are the big issues here? What are the problems?" And those lists of problems are a table of contents; it is a way of indexing information for patient care. When you compare that to the traditional medical record, which is essentially a stream of consciousness, you begin to see the organization of medical information, as you put it in, has all kinds of

possibilities.

PP: How does a problem-oriented EHR organize data?

JG: You can link decisions made to diagnoses over time. When you look at a [medication] list you can see that a certain medicine was prescribed at a certain time and linked to a certain diagnosis. Or that a certain test was linked to a certain diagnosis. And this is part of the intelligence that [developers at MGH] built into [the] software. We are using our own internal algorithms to do this for the physician.

In addition, we have ways of looking at your previous behavior around a given problem, and using that to pre-populate some of the decision making that you would be expected to make. So if, for example, your first choice of drugs for hypertension is, 90 percent of the time, hydrochlorothiazide … all you would need to do is navigate to the medication writing page, hit hydrochlorothiazide, and everything would be put into the prescribing tool. The same thing can be done for laboratory testing. … Once you have a database on the physician's decisions, you can use that to accelerate the work.

PP: Why would a problem-oriented EHR make the physician's job easier?

JG: …We understand the regulatory world and we know what's out there. We know what the world expects of doctors; that's pretty clear. [Our goal was to] design a system that helps to organize and retain the data to answer the questions that people [have] ... And then within the practice itself give the physician back the most precious thing, which is time with patients.