Joining the trend of patient goal-oriented electronic health record

Tino Martí
 

Primary care in our country is in a good situation regarding the use of electronic medical records. The digitization of medical records began at the end of the last century and was fully deployed in the first decade of this. Such is the progress of the clinical stations used today that they are already crying out for a technological, functional, and usability update, but changing the system is complicated and very expensive, so it's easy to expect that change will only occur when the technological version will no longer justify itself.

Recently, Mònica Almiñana put us on the path of goal-oriented care in her article ""Carried me with you": the objectives of integrated care are a matter of more than one", which has sparked some debate among various readers.

The concept of goal-oriented care is not strictly new. In 1991, two articles on the subject were published in the journal Family Medicine. In one of them, Mold et al. defined the goal-directed care model as "the approach that uses patients' life and health goals to guide health professionals in co-creating personalized care plans that respond to patients' priorities, needs, preferences, and values" shared by patients. In recent years, its discussion has been revived as it's one of the mechanisms for developing person-centered care, overcoming the biomedical model, and advancing in socio-health integration. 

As the comments of the readers point out, it's difficult to move towards this model without the necessary levers of change, such as evaluation and payment systems. But today let's focus on the lever of the electronic medical record.

Directing medical history to personal health goals

In Moving from problem-oriented to goal-directed health records, Nagykaldi, Tange, and De Maeseneer propose five functions to consider when redesigning health records that seek to embrace personal health goal orientation:

• Support elements for patient involvement: through the patient's main profile, longitudinal and with health objectives, levels of achievement, barriers, and facilitators that help shared decision-making.
• Personal determinants of health: health planner, longevity, health-related quality of life, personal development, social and family context, advance directives.
• Shared clinical notes and data: follow-up of the care narrated by the patient and integrating data of vital events and health.
• Integration and interoperability of services and data: interdisciplinary communication and interoperability of data from different sources.
• Integration of community health: detection of data and signals that respond to individual and population’s health objectives.

Some of these factors are already included in current electronic medical records. See, for example, the Individualized and Shared Intervention Plan (PIIC) of the shared clinical history of Catalonia. Others are not yet but can be easily incorporated. However, the authors consider that the first two – the support elements for patient involvement and the personal determinants of health – are the fundamental ones to approach the goal-oriented care model and that they are not deployed today. The development of these modules could also be carried out through the evolution of personal health histories that citizens access, ideally from mobile phones, providing them with a higher level of interaction and facilitating the incorporation of data provided by the patient that help measure the value of shared care and decision-making.

Given that investments in information systems are very long-term, it would be convenient that sufficient time would be invested in their redesign in the next cycle of technological renewal. Reflection on the care model and the participation of professionals and patients knowledgeable in the co-design process can help prevent the perpetuation of outdated schemes and guarantee transformation beyond mere substitution. And if the train has already passed, at least current technologies are much more flexible than before.