Encore! EP392: When Patient Journeys Don't Fit in the EHR, With Emily Kagan Trenchard

Electronic health records were purpose-built for billing — some have called them glorified cash registers — which means the vast majority of a person's health-relevant life never gets captured anywhere. Stacey Richter re-airs this conversation after attending both the NODE (Network of Digital Evidence) conference and an employer-focused summit with the Pittsburgh Business Group on Health, because what Emily Kagan Trenchard describes isn't a nice-to-have for digital health entrepreneurs; it's a must-have for the self-insured employers quietly paying for every fragmented, unsupported patient journey through escalating commercial rates. Emily is SVP and chief of consumer digital solutions at Northwell Health, New York State's largest health system (21 hospitals, 850 outpatient clinics, 300,000 patients a year), and a former spoken-word poet who now works to put the human back into healthcare's digital infrastructure.

WHAT YOU'LL LEARN

✅ Why EHRs, built around federal billing mandates, only capture the narrow slice of a person's life when they're actively a "patient" in a clinical encounter — and why everything that happens on someone's couch, with their COPD medication or their support network, falls outside that architecture entirely

✅ Emily Kagan Trenchard's four "tentpoles" health systems need to properly support patients and everyone around them: the EHR, a CRM (treated as a relationship-building philosophy, not just software), a cloud platform for data and analytics, and a data exchange

✅ The two facts driving Emily's thinking: providers and patients are increasingly intolerant of friction, and whatever is easiest is what people will actually do — the same logic Amazon and Google already build around

✅ Why treating population health seriously means understanding a patient's network of relationships — caregivers, family, community — not just the patient as an isolated data point, something EHRs are structurally unsuited to do

✅ Why non-purpose-built technology doesn't just frustrate patients; it drives clinician burnout and turnover, which is its own expensive, measurable cost to health systems

WHY THIS MATTERS

Every fragmented, friction-filled patient interaction that falls outside the EHR's billing-shaped architecture is a cost somebody eventually pays — usually the self-insured employer footing the bill through ever-escalating commercial rates. Emily Kagan Trenchard's framework reframes digital health investment not as a marketing or patient-experience nicety but as core infrastructure, on par with the clinical tech stack. Health systems that keep defaulting to the EHR as the center of the universe are optimizing for billing, not for the actual people — patients and everyone around them — the system is supposed to serve.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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00:00 Introduction

07:08 How does customer digital solutions fit into the larger technology infrastructure in healthcare?

09:07 "Where else do you have centers of gravity that you should respect in the architecture?"

09:25 "There is a constellation of need here."

11:05 "We interact with way more than just patients."

13:42 "We have to be able to understand the network of relationships in a population."

14:25 How do EHRs and CRMs interact as two tentpoles in healthcare?

16:45 "The question is, where does a human being work?"

19:07 How are patients staying on a nonfragmented care journey in a proactive way?

23:00 "Anybody who's a consumer of our digital offerings has a relationship with us."

28:46 "The medicine is being practiced not only on our physical bodies but on our digital bodies."