I first blogged about EHRs back in 2008 and have been using a full-service EHR for all my documentation and computer physician order entry for more than two years. While I talked in my last post about the nitty-gritty details of using an EHR, I’ll take this opportunity to reflect on my experience so far and ponder future possibilities.
It’s often said that the success of any new technology depends not on the technology itself but on how we harness it. Granted, this simplistic view does not reflect the complexities of rolling out an EHR, but it has a kernel of truth.
Also true is the fact that we are way beyond any debate on whether we need electronic health records. In the last two years, EHRs have become the new reality. The questions today are: How do we better utilize EHRs, and do these systems live up to their vaunted promise?
I have witnessed physicians ranting and raving against EHRs; notice the past tense! While a few have only grudgingly gone along with them, most have embraced them wholeheartedly.
Typing skills have certainly improved, and colleagues routinely take work home on busy days to fill in notes remotely. The upside is that they do not have to stay in the hospital way beyond their shift, part of a general trend in many other industries toward “flex work,” thanks to remote connectivity.
Even more importantly, patients have accepted EHRs. I have yet to hear patients ask me to not bring a mobile work station into their room. They do not mind data being entered while an MD or an RN talks with them. I have also not heard any negative comments from nursing staff in terms of decreased face-to-face interaction with the hospitalists.
Too, the hospital system where I work has recently integrated its EHR with a large independent outpatient multispecialty provider. It has been a breath of fresh air to be able to review a patient’s recent work-up and not have to duplicate it. Plus, it provides much more insight into a patient’s medical situation.
But I do see some areas of concern. As EHRs are rolled out, for instance, it is clear that medical IT infrastructure, especially on the software side, is well behind what is happening in non-medical fields.
One could argue that compliance issues such as HIPAA act as a damper preventing systems from becoming more user-friendly for both providers and users alike. The search function of any EHR is nowhere near as facile as search engines like Google and Bing. And I have yet to see a medical Web site, particularly one for a hospital, that is as intuitive as any good Web page for a hotel or airline.
I would love to see EHRs that can be configured to generate meaningful “dashboards” in real time. (Dashboards are essentially data displayed in user-friendly format, similar to what a pilot sees while flying: altitude, aircraft and wind speed, engine performance, positional/spatial data, etc.)
In any profession, real time data are essential to know how one is performing both individually and as part of the larger care process. Not having this data is like flying in a fog without any navigational instruments. Imagine an EHR that tells a hospitalist pertinent metrics such as length of stay, medication errors, near misses, time to initial admit orders once a patient arrives on the floor, delays in imaging/tests, patient outcomes, etc.
Or how about a smart phone “app?” Choosing pertinent and meaningful metrics that have a positive impact on clinical practice instead of becoming annoying distractions is a whole topic by itself.
Do EHRs save costs? I honestly do not know. I am certainly looking forward to future data regarding cost savings on the back end once hospital systems have invested millions of dollars on the front end to roll out an EHR. One interesting aspect of EHRs is that a new industry of experts has sprouted who are being hired by plaintiffs’ attorneys to forensically dissect an electronic chart!
Then there is the whole issue of social networks and cell phone connectivity–an entire universe where health care software technology has not made much of a dent. How we utilize social networks and smart phones is limited only by imagination.
Electronic PHRs (personal health records) have yet to take off in a big way. Big software companies such as Microsoft (Health Vault) and Google (Google Health) have made forays into PHRs. I believe the next big thing in electronic health care will be the evolution of a popular electronic PHR that can interface with multiple EHRs and harness the benefits of social networking and smart-phone technology, without of course violating HIPAA.
A word about HIPAA laws: We are all one diagnosis or test result away from either being stigmatized or discriminated against. So, I am all in favor of secure health information. If financial information can be handled in a secure manner and essentially the entire financial system is now digitized, I am pretty sure the technology exists to ensure HIPAA compliance, yet allow for expanded meaningful electronic interaction between providers and consumers in a more facile, consumer-friendly way.
This is a tall order indeed, but very much in the realm of possibility. Imagine patients being able to fill out an intake chart on their smart phone prior to a doctor’s office visit and get health alerts or reminders on that phone, while their PHR imports relevant information from EHRs without having to manually input it. Some of this technology already exists piecemeal, but the company or entity that can make this possible seamlessly could very well reap untold financial benefits.
One natural offshoot of ubiquitous EHRs (and eventually PHRs) is telemedicine. Remote access medicine has been quite successful in niche fields such as electronic ICU monitoring and the spoke-and-hub model connecting large, tertiary care stroke centers with rural emergency departments for remotely assessing patients for intravenous tPA administration. As the population ages, compliance requirements increase and human capital remains limited as well as expensive, it’s clear we have only scratched the surface of telemedicine.
In February 2009, the president signed a new law, the Health Information and Technology for Economic and Clinical Health (HITECH) Act as part of the stimulus package.
The goal is to provide financial incentives for rolling out EHRs, and the act mentions “meaningful use” of electronic health information.
How does one define meaningful use: meaningful to the health care provider, the hospital system or, most importantly, the consumer? One thing is for sure: What is meaningful today will be very different from what is meaningful 10 years from now when increasing numbers of the hyper-texting denizens of current social networks are active and paying participants in the health care industry. Will health care software evolution keep up with the pace at which the wireless, interconnected cyber world is evolving?
The digitalization of health records and care processes is a game changer in ways we have yet to quantify. Above all, it may very well change the very definition of what constitutes “the good doctor.” KMFC! (keeping my fingers crossed!)