EHRs in a Web 2.0 World: Time to Embrace a Problem-List Wiki

The United States healthcare system is highly inefficient, with high costs and suboptimal quality. Electronic Health Records (EHRs) can help address the dual problems of high costs and poor quality in health care by improving communication between providers and health care facilities, decreasing errors, preventing duplicate test ordering, standardizing care by improving adherence to guidelines and engaging patients in managing their own health. Unfortunately, in spite of their promise, thus far, EHRs have failed to lead to significant improvements in outcomes in patient care. EHRs are multi-author documents, with contributions from multiple providers collaborating on the care of a patient. Presently, a patent’s EHR consists of independent notes, with a new note created at each point of contact with the patient, rather than a shared, continually updated, well-organized summary of the patient record. To get a full perspective of the relevant health issues, providers must review all of the individual notes. Contrast this to a Wiki, where multiple authors pool their knowledge by collaboratively authoring shared documents on various topics. The Wikipedia, based on the Wiki model, has some pitfalls, but it hosts the world’s information in an up-to-date, easily searchable format. Why can't the EHR be more like a Wiki? The concept is not new; the benefits of a Wiki-like Problem-Oriented Medical Record (POMR) were outlined in the 1960s. Let us first examine some reasons why we have the current suboptimal model for documentation in EHRs. Then we will explore the model of a Wiki-like problem list in the EHR.We conclude by listing several drivers in the current healthcare landscape that may help achieve such a Problem-List Wiki (PLW).