Fragmented EHRs

Out of the many fears that I have as I transition from residency to becoming an attending is related to communication, specifically regarding electronic records and communication. As a family physician working in primary care, I frequently must juggle racing against the clock and trying to figure out what happened to the patient in front of me outside of my care. Often, I see a patient that is new to my clinic for whom I have no records and have no ability to quickly access their records, as their previous charts are stored in a electronic health record system for which I do not have access. All to often I see patients being managed by multiple specialists, or who was recently hospitalized, for whom I have no records. Sometimes, despite my clinic’s efforts to obtain these records, we never receive anything. For new patients, this potentially can lead to harms in terms of delays in care, or unnecessary repeat testing that places additional financial burden to the patient or the system as a whole. For patients seeing multiple specialists, my ability to help my patients coordinate fragmented care is significantly limited by this problem. The obvious fix is to have a universal electronic record or have EHRs that communicate well with each other. Community health information exchanges is one step in the right direction, but they are still far from their potential usefulness. In the meantime, however, I will need to continue to find systems that maximize my ability to obtain records despite the deeply fragmented nature of our EHRs.

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