Rethinking the electronic health record through the quadruple aim: time to align its value with the health system

Abstract

Electronic health records (EHRs) are considered as a powerful lever for enabling value-based health systems. However, many challenges to their use persist and some of their unintended negative impacts are increasingly well documented, including the deterioration of work conditions and quality, and increased dissatisfaction of health care providers. The “quadruple aim” consists of improving population health as well as patient and provider experience while reducing costs. Based on this approach, improving the quality of work and well-being of health care providers could help rethinking the implementation of EHRs and also other information technology-based tools and systems, while creating more value for patients, organizations and health systems.

Effects of Electronic Health Record Implementation and Barriers to Adoption and Use: A Scoping Review and Qualitative Analysis of the Content

“…Our results, which suggest mixed findings with a predominance of positive effects and some negative effects of EHR implementation, include improved efficiency, decreased efficiency, better communication, improved accessibility and enhanced quality of care as some of the identified major effects. This is in line with a recent review which mentioned that the findings of the early literature on EHR effects on care quality, communication, and information management were notably mixed [158,159]. Despite the overall positive findings, in more recent research, mixed results and unanticipated negative consequences (e.g., disrupted workflow) were still reported [158].…”

Nurses’ experiences and viewpoints about the benefits of adopting information technology in health care: a qualitative study in Iran

“…underutilization and reluctance to use IT, sabotage, nurses’ resistance to IT implementations, and unfavorable attitudes toward IT) to the successful interaction of nurses with IT in health care, and fitting IT into the workflow of nurses is challenging [ 6 , 8 ]. The lack of IT adoption can result in unintended negative consequences such as anxiety, fear, a desire to return to paper system [ 9 ], deterioration of work conditions and quality, dissatisfaction, cognitive overload, exhaustion and sense of ineffectiveness [ 10 ]. Other reported consequences are the failure of IT implementations, or suboptimal user-system interactions, which in turn lead to nurses’ frustration, and adverse patient outcomes [ 11 ].…”

Empowering patients to adhere to their treatment regimens: A multifaceted approach

“…Such evaluations no doubt take time and require active listening and responsiveness. Yet, in an era of increasing technology and demands for efficiency, healthcare providers often feel constraints of time and endorse impaired ability to connect with patients and families 33. A few recent studies suggest novel approaches to model healthcare system infrastructure to support adherence and illustrate some challenges with feasibility and effectiveness.Kelly SL et al recently reported on a home-based telehealth group adherence intervention conducted to overcome distance barriers.…”