Health IT

EHRs, PHRs designed to fail, says Welltok CEO Margolis

"Interoperability is a synonym for bad system design," said Welltok CEO Jeff Margolis, who believes that EHRs need to become more holistic, longitudinal and patient-centered.

“Interoperability is a synonym for bad system design,” said Jeff Margolis, CEO of Welltok, a Denver-based company that helps people manage their health.

In an interview with MedCity News, Margolis also expressed the belief that current electronic health records and personal health records are unintentionally designed to fail. “We’re not condemning the use of EMRs or EHRs or PHRs,” he said. However, Margolis said he believes there is a “misunderstanding” about what they should be.

Hospital or physician EHRs usually just cover that specific clinical setting. “They’re episodic,” said Margolis. “People think that the exposure of data to the patient outside of clinical systems is interoperability,” he said, but he dismissed that notion. “The systems are not designed for getting holistic data to the patients,” Margolis said.

“You’re just fragmenting consumers now,” Margolis continued. He then questioned the commitment of major enterprise EHR vendors: “Do you really think they’re interested in creating” real interoperability? “You need to have an agnostic, neutral, Switzerland type of system.”

According to Margolis, a properly designed EHR should have “a holistic view of the consumer attaching them to the right data instead of extracting data from silos.”

Adding payer data makes records more longitudinal, according to Margolis, who also founded payer-focused health IT company TriZetto, a once-public entity that he sold to private investors for $1.4 billion in 2008. But that still is not good enough, because EHRs — like healthcare itself — tend to be episodic. “It’s only longitudinal to that patient crossing that setting,” he said.

Patients should think about more than just care in traditional healthcare settings, Margolis suggested. They should think about fitness, nutrition and behavioral health, among other factors.

“Patient portals from clinical systems are necessary but not sufficient,” he said. “The same goes for [insurer] member portals.”

Health IT systems need to be built around patients, not payers, providers or even diseases. “Incentivize consumers in addition to providers and payers,” Margolis said. “You’ve got to give them a multidisciplinary pathway” to encourage self-management of health.

Corporate wellness programs, which have come under fire from other sources lately, tend to be “one-size-fits-all” or a “blunt instrument where people become their diseases,” Margolis said. “They fail the same way they would if you took 100 consumers and brought them into a store but the store only had three items,” Margolis said.

“We need a new [nonclinical] consumer supply chain,” Margolis recommended. There also has to be proper coordination between consumer understanding of benefits and value, such as when to use urgent care rather than an emergency room.

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