EHR Pitfalls that Lead to Gaps in Care

Electronic Health Record (EHR) systems are pivotal for growth and advancement in healthcare, but they also present unique challenges. Issues like variability in EHR use rushed implementations, and lack of interoperability can highlight or exacerbate care gaps. 

One major challenge is the variability in how EHRs are used, leading to inconsistencies in care. Effective care coordination requires standardized workflows among staff. EHRs often provide documentation guidelines for specific value-based care measures, but these guidelines are not always uniformly followed. In larger health systems, multiple and often inconsistent workflows are common. Some providers may use free-text fields for encounter notes, others may document the same information in different fields, and some might be untrained in checking all available data points to identify care gaps. These variations can result in costly gaps in patient care. 

The implementation of EHR systems itself can also create care gaps, especially when rushed. This rush can be due to financial constraints, lack of interoperability, or concerns about physician adaptation. Many health systems, especially smaller practices, struggle to invest adequately in training, support, and infrastructure. Insufficient planning and funding can lead to incomplete implementations, where data is not fully integrated, staff are inadequately trained, or specific requirements are unmet. Often, organizations set a go-live date without ensuring all data is merged correctly or all staff are fully trained. Subsequent plans to implement additional functionalities or migrate systems can be deprioritized, exacerbating care gaps. 

Lack of integration between systems further contributes to care gaps. Effective patient care, especially after a significant health event, requires seamless communication among all members of the care team, including mental health counselors and housing specialists. However, outside of healthcare or hospital settings, access to EHRs is often unavailable, leading to reliance on slow or incomplete communication methods like snail mail, emails, or paper documentation. This fragmentation in communication can significantly impact patient care. 

Even when patients are seen outside their primary healthcare provider or system, differences in EHR systems can create barriers. External practices often use different EHRs, necessitating the transfer of medical records as electronic PDFs or paper documents. This lack of EHR interoperability disrupts efficient data sharing, resulting in repeated tests and incomplete medical information for decision-making. 

Most care gaps stem from inconsistent workflows and incomplete health information transfer. To address these issues, practices should invest time post-implementation to identify and standardize workflows and train staff accordingly. EHR vendors can assist by adding necessary fields for specific specialties and ensuring critical fields are mandatory. Utilizing data dictionaries with drop-down menus and pre-populated fields can standardize workflows and facilitate data analysis. Most importantly, improving communication between integrated systems is crucial for closing care gaps and enhancing patient outcomes.