Beyond EMR: Care Management with Intelligent Pathways

In a recent article published by JAMIA (Journal of the American Medical Informatics Association), an AMIA task force outlined five broad goals that will improve the value that EMRs provide to patients, who are the ultimate customers of the Healthcare system. The goals summarized in a Healthcare IT News article generally aim to facilitate care delivery, foster innovation, and prioritize efforts on patients.


One way to redesign in order to produce patient-centered care delivery is to focus on satisfying patient interactions in terms of experience and outcomes.  Taking a page from each of the playbooks focusing on patient journeys, applications of Design Thinking to better serve the patients, and use of care pathways to deliver better outcomes, it seems that the natural progression is an EMR design that considers all actions, actors, and artifacts (data included) in the patient’s care journey. 


Imagine such design attributes:


1) No specific interfaces, all participants - doctors, clinicians, DME vendors, SNLs, patients, loved-ones, other care providers, etc. - have some way to access what they need, and to add to the EMR the actions they have taken.

 2) The “backbone” that holds all participants and their actions together is an intelligent pathway that drives even seemingly disparate actions toward the care goals, and possibly even toward each organization’s goals

 3)Only information needed to move the patient along toward a better stage in the pathway is required. That way, no one needs to solve the difficult problem of collecting data from all organizations involved with the patient. But this means that the pathway, again, is intelligent enough to know, prompt for, or even automatically ingest the required data.


Now all participants are privy to the patient's requirements, and are guided accordingly toward the goals. The intelligent pathway even takes care of scheduling, as most participants cannot afford the time and efforts to track the patient's current pathway position, let alone identify the next required action. EMRs will still do what they do best – store data safely and maintain necessary privacy – but information access, decision making, and actions to take are now happening concertedly in the full social context of patient care. The intelligent pathway acts like an “Invisible Hand”, guiding the entire “care project”, which in many cases is lengthy and involves many agents, as they move toward the expected outcomes.

Grace Chen