The Problem with EHR Workflows—Why It’s Time for a Redesign
The EHR Conundrum: Outdated Workflows from a Paper Era
Electronic Health Records (EHRs) were supposed to revolutionize clinical care—at least, that was the promise. But as any clinician will tell you, they’ve done anything but that. Instead of workflows built around patient care, EHRs have rigidly enforced a structure that feels like an endless, digital filing cabinet—filled with data, yet devoid of the context and organization that makes data clinically useful.
In reality, the problem lies in the origins of EHRs. They were designed to move paper records into digital form, not to reimagine how clinical information could be managed. This is why we have a tab for notes, a tab for labs, a tab for images, and a tab for meds. This mode of data organization reflects the physical charts that EHRs were built to replace. The goal was data storage and a digitization of paper workflows, not a philosophical assessment of how digital clinical workflows could evolve beyond their paper counterparts. And, because the incentives focused on adoption rather than transformation, these systems received the green light without ever needing to rethink their core functionality. This is why the problem list does not reflect documentation or diagnoses attached to medication and lab orders. The EHR is a collection of disjointed processes brought together into one platform, without much thought into how the pieces should fit together.
A Misalignment in Data Organization
In the current EHR landscape, data is siloed by type: medications, labs, notes, images, each in its own section, often ordered by date, status, or data type. This might make sense to a computer, but it makes little sense in the context of clinical care.
When I review a patient’s chart, I’m not looking for a list of labs or images by date—I’m looking to understand the patient’s health by problem, to assess what’s been tried, what’s working, and what needs to happen next. And yet, EHRs are organized to make this as difficult as possible.
All the clinical data we enter—orders, meds, labs, imaging—are tagged with their relevant purpose or medical problem during the ordering process. But once they’re in the system, this information is essentially buried and given no priority beyond its creation date. EHRs force us to sort through these disorganized lists, wasting time and increasing the chance of oversight.
The Need for Purpose-Driven Organization
Imagine a different approach: a problem-oriented organization where every piece of data—every lab, every note, every image—is stored and presented by medical problem. A chart where all relevant information is gathered together, allowing you to immediately understand a patient’s situation and history at a glance. And, when a glance isn’t enough, the deeper clinical insights and data are available with a click, not a meandering through the historical data tables that take time and effort to navigate.
This isn’t just a convenience; it’s essential for clinical decision-making. When clinical information is organized by problem, it empowers clinicians to make informed decisions quickly, to see patterns, and to track progress over time—all without the cognitive burden of trying to make sense of fragmented data.
A Call for Change
The time has come to move past the legacy systems that have held us back and to design tools that serve clinicians, not the other way around. At River Records, we’re building problem-oriented solutions that don’t just store information but actively help clinicians work smarter and more effectively. Because in the end, a well-organized chart isn’t just a nice-to-have—it’s a tool for better care, greater efficiency, and, most importantly, improved outcomes for patients.
