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IHI’s Goldmann: Making Explicit the Link Between EHRs and the Triple Aim

May 2, 2014
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Dr. Goldmann’s speech reminded HCI Executive Summit attendees of the bigger-picture issues around EHRs

Don Goldmann, M.D.

Don Goldmann, M.D., the chief medical officer and chief scientific officer of the Institute for Healthcare Improvement (IHI), the Cambridge, Mass.-based independent organization advocating for transformative change in healthcare, gave a bracing opening keynote address at this week’s Healthcare Informatics Executive Summit. With his wealth of knowledge and his passion for the cause of the Triple Aim (improved patient safety and care quality, reduced cost, and enhanced patient and community centeredness and engagement), he laid out a great case for the transformation of the U.S. healthcare system, for attendees gathered at the Mark Hopkins Hotel in San Francisco.

Dr. Goldmann urged healthcare IT leaders to work as closely and collaboratively as possible with quality improvement leaders in order to transform the U.S. healthcare system on behalf of patients and communities, and he made clear that he was more than willing to sit in dialogue with IT experts in healthcare. “I think that we need to understand what you guys accomplish, and to change healthcare systems to accommodate what you’re doing, and vice-versa,” he said early on in his speech.

But he was equally open in making his point that electronic health records (EHRs) are fundamentally problematic in a number of ways, when it comes to all the things they could be doing to support clinical transformation. Among the things most EHRs don’t do, according to Dr. Goldmann: they don’t support the basic functions of patient-centered medical homes and “medical neighborhoods”; don’t support robust panel management and the creation of patient registries; they don’t enhance care team communication or handovers in real time; don’t help develop coordination with care managers and community health workers; don’t effectively track abnormal lab test results and their resolution; don’t provide adequate referral to specialists or feedback from specialists back to primary care physicians and patients; don’t support patient-reported outcomes measurement; don’t integrate with patient self-management apps; and don’t provide for rich clinical data mining.

Dr. Goldmann made numerous very important points about what EHRs should do: they should be made less expensive to install; should support clinical practice guidelines and pathways; and should provide broader overall clinical decision support capabilities, among other things.

More broadly, Dr. Goldmann offered very persuasive arguments for why everyone involved in attempting to implement the concepts of the Triple Aim in healthcare should do everything possible to move EHRs from their current state towards a far more robust architecture that supports clinical transformation. He created a strong portrait of the bridge between informatics and clinical transformation and the Triple Aim; and it is that bridge, he argued very persuasively, that will get us from here to there, when it comes to profoundly altering the process of care delivery in order to move healthcare in the U.S. towards a more proactive stance when it comes to improving the health not only of individuals, but of entire communities and of the nation. It’s precisely “big-picture” presentations like these that more healthcare leaders need to hear, as we all prepare to move forward into the new healthcare. I’m grateful to Dr. Goldmann for reminding us of the bigger picture, and for having framed the issues so beautifully at the start of a day and a half of great discussions in San Francisco.