Box 1.

EMRs and Care Coordination: Lessons Learned

▪ EMRs, as currently designed and used, are helpful to coordination of care within the practice because they make some data available in real-time when it can be used for decision making with patients; but they are less helpful to coordination between clinicians across practices

▪ Present day EMRs are designed for linear (point-in-time) documentation, whereas coordination of care is a dynamic process

▪ Managing information overflow that can result from EMRs can be challenging for care coordination (e.g., repetitive content of notes and inappropriate use of templates can hinder coordination because it is difficult to identify important clinical information)

▪ The benefits of the EMR to coordination are limited if one simply uses the EMR as a paper chart

▪ Initial and ongoing investments are required to maximize the EMRs’ utility for care coordination

▪ Maximizing the potential of an EMR for coordination involves ongoing evolution of clinical care processes as well as clinician input on EMR design modifications and standards for data exchange to support those processes

▪ Research aimed at developing EMRs that better support care coordination is necessary

▪ Modifying reimbursement to encourage coordination of care by clinicians will likely drive clinicians to demand better EMR functioning to support coordination

▪ Simply creating incentives to adopt EMRs as they currently exist, given the confines of the current payment system, may result in the EMRs being designed for billing purposes primarily rather than for clinical relevance to patients and care coordination