Win Whitcomb: Inflexible, Big-Box EHRs Endanger the QI Movement

Help Needed: Open Systems and Modular Architecture

Today’s EHRs can be thought of as monolithic and closed, with an all-or-nothing, static set of features. On the other hand, think of your smartphone and all the apps (modules) you openly download and, if desired, you delete. This is the vision of a healthy, open, modular EHR ecosystem:

• Imagine a busy clinician providing real-time feedback about a negative or user-hostile feature in the EHR;
• Imagine that feedback incorporated—in days or hours—by engineers to create a new version of the application;
• Imagine a VTE prevention QI team conducting a Google-style search of a group of patients to determine rate of pharmacologic prophylaxis and average VTE risk of that group; and
• Imagine a hospitalist having five apps to choose from to automatically calculate the readmission risk of a patient: You could choose the best one and delete the others.

The Office of the National Coordinator for Health Information Technology has awarded a series of grants through the Strategic Health IT Advanced Research Projects (SHARP) program to help solve the vexing problems of our closed, innovation-stifling EHR environment. The output of SHARP will be “improvements in the quality, safety, and efficiency of healthcare, through advanced information technology.”

It won’t happen overnight, but perhaps we can hold out hope that there will be a day when EHRs help, not hinder, the QI process.