EHR-first or high patient engagement? There are pros and cons to both approaches.
Since 2020, health systems have diverged in digital health strategies for patient journeys (e.g. pre- and post-surgery care) into two main camps.
Camp 1: “We will deliver the best digital experience for patients that delivers the highest patient adoption, engagement and outcomes – we’re not married to the incumbent.”
Camp 2: “We are EHR-first – we prioritise a completely unified system to ensure tight integration, data integrity and a more cohesive technology experience.”
Having been in the digital care journey space for 13+ years now, I’ve had a front-row look at these approaches: what’s worked, what hasn’t worked.
Here are my seven observations of health systems deploying digital care journeys as of 2026:
- Digital care journeys only thrive if there is an executive leader who is personally passionate about championing digital health for patients at scale across the enterprise. While this is true for most innovative technologies, it’s especially true in a time when there is more exuberance for working on AI clinician initiatives (e.g. AI scribes).
- Everyone underestimates the people and process required to make digital care journeys work – including content customisation and maintenance, staff change management, continuous iteration of workflows. Many assume this is a “one and done” implementation process … it’s not (but it can take health systems one or two years to truly realise this).
- The EHR-first approach can work well when the needs are low: smaller organisation, simple pathways (e.g. covid monitoring), few ongoing pathway changes, no tight timelines to implement and scale across the enterprise.
- The purpose-built third-party approach works better when the needs are high: larger organisation, complex pathways (e.g. heart surgery, oncology), regular content and pathway maintenance (including a desire for continuous improvement), goals to improve clinical outcomes and a desire for rapid scale across a dozen or more clinical areas.
Related
- Clinical evidence (or lack thereof) has mixed value for decision makers. Often EHR gravity and a desire for complete technology unification supersedes the risk that patient adoption, engagement and outcomes will have lower results.
- Despite that, many health systems eventually transition to the purpose-built third-party approach because the ongoing maintenance of the EHR-only approach at scale across increasingly complex clinical areas is unsustainable – provided that the solution has turnkey EHR and patient portal integration, which helps satisfy the majority of IT leadership desires.
- Contrary to one’s intuition, there hasn’t been a correlation between IT resources and being EHR-first. Some of the smallest organisations are more successful with EHR-first approaches because they have the least complexity – for example, it is easier to get fewer clinicians at a one-facility system aligned. Conversely, achieving pathway alignment across a 10+ hospital system is a headache for even the most highly resourced health systems.
Dr Joshua Liu is a Canadian physician turned cofounder/CEO of SeamlessMD, a health tech company which enables CMIOs, CIOs and health systems to digitise patient care journeys with automated reminders, education and symptom monitoring – leading to lower length of stay, readmissions and costs.
This article was first published on Dr Liu’s LinkedIn feed. Read the original article here.