1. Michael Raddock, MD. Department of Family Medicine MetroHealth Medical Center Cleveland, Ohio

2.  The EHR is a relatively new tool that is in a state of evolution and is changing based on the priorities of the designers and buyers of these systems as well as payers and regulatory entities.  Like any tool, the EHR will have strengths and weaknesses depending on it's design as well as the skill and experience of the users.

3.  Many EHRs are currently optimized for billing, coding, capture/analysis/display/retrieval of granular data.  EHRs are part of health care systems that further influence their optimization and use.  Financial incentives from the government such as Meaningful use and Patient Health Quality Reporting influence the design and prioritization of EHRs.  Insufficient input from clinicians and patients

4.  There are areas of convergence and divergence when one looks at the priorities of purchasers, payers, and designers of EHR’s, as well as those of clinicians and the patients.  Patients and clinicians may want systems that are optimized for: strengthening patient- clinician relationships, fostering co-created narratives, communication, collaboration, and patient self-efficacy.

5.  It depends on the clinician and the situation!  Optimized for relationship building, improving patient engagement and efficacy, making administrative/documentation easier.  Optimized for images (dermatologists)  Optimized for granular data capture, retrieval, and analysis (quantitative researchers)

6.  To help their providers and health systems to keep track of their information reliably  To have information more easily shared among providers and facilities  To help avoid mistakes  To help them feel heard and valued as individuals  To help them be healthy

7.  To help track costs, quality (process and outcomes), and variation  To automate the administrative work as much as possible  To improve the bottom line

8.  Large EHR vendors (such as Epic) are interested in increasing profits and market share by working with large systems.  EHR designers want clarity about interoperability, customer priorities, and user interfaces so they can meet buyer’s needs.

9.  EHR's are still in their relative infancy in terms of being optimized for the many specialized tasks that occur in health systems.  Future evolution of EHRs will be influenced by the priorities and incentives of the designers and buyers of these tools.  Behavioral scientists and patients should have a role in the design and optimization of EHRs that reflect our priorities.