Electronic Health Records: Design, Implementation, and Policy for Higher-Value Primary Care

Abstract

Electronic health records (EHRs), and the policies andworkflows around them, are inconsistently aligned with the needs of primary care patients and physicians. This results in substantial waste of physician and support re-sources, high rates of burnout (1, 2), and a decrease in primary care capacity precisely at the time when our nation needs a stronger primary care foundation (3). We propose a set of principles (Table) directed toward vendors, institutional leaders, policymakers, and physicians to support higher-value primary care. These principles draw on our expertise in patient care, quality assurance, industrial and systems engineering, and policy and EHR implementation. They are inspired by discussions with cli-nicians after more than 100 presentations on redesigning primary care practice and our shadowing of physicians at nearly 50 sites. We hope they will contribute to a multi-stakeholder dialogue and serve as a call to action.

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