EHRs and Contexts of Use

When considering the increase in quality expected with more pervasive EHR technology, it's important to define: quality for whom? In what context? How do we define and measure quality in different situations?

It's not a new concept. Most modern EHRs, descending from products designed for a desktop experience, are out of date in terms of mobile access. As phones, tablets, and other devices bring a desktop's display and processing beyond its stationary role, software systems are expected to follow along, providing a continuous experience across a variety of new contexts and platforms of access.

Demands on healthcare providers leave them with a strong need for timely access to relevant medical information, in both inpatient and outpatient settings. Yet particularly with regard to interactions between doctor and patient, there is a delicate balance between technology that supports vs. technology that interferes. This balance becomes difficult to achieve as technology is expected to support increasingly varied and complicated workflows in clinics and hospitals alike.

Today's complex inpatient and outpatient EHR systems represent significant differences between both forms of care and the organizations that support them. They have different challenges, processes, certification criteria and measures for clinical quality. Efforts to integrate them in a single platform have focused on facilitating the efficient management of workflows, information exchange, and documentation. But this is not enough. We have to understand the fundamental human experiences and priorities of physicians and their patients in different contexts of care to develop the next generation of innovative EHR solutions.

In conversations with doctors from The Brigham and Women’s Hospital, MGH, Cambridge Health Alliance, and other health organizations, we looked at how providers are adjusting to rapidly increasing standards for digital information in healthcare.

In this report we explore how EHR systems need to be designed with a better understanding of the different contexts of practice for healthcare professionals and the flexibility required to satisfy their emerging needs.