Thursday, June 14, 2012

We Need to Leave the Complex Legacy EHR Systems for Something Better. Here's How

Years ago, when the physician Disease Management Care Blog was first grappling with an electronic health record (EHR) system, it couldn't:

  • manage any text with basic word processing tools;

  • review a patient's summary data (like all cancer screening tests over time);

  • review its patients' summary data (like blood pressure control among all persons with a diagnosis of hypertension);

  • communicate with patients outside of an unwieldy messaging system;

  • perform outcomes research (based on a look-back, which approach worked better?).

  • support key elements of population health management, like risk stratification or facilitating nurse-physician care plan work flows.

  • What it could do was continue to see patients one-at-a-time, type (not write) a clinic note, click (not mark) the tests it ordered and bill a lot more for its services.  And what the DMCB's clinic could do was spend a lot of money on health information technology that was siloed (unable to communicate in any fashion with any area hospital) and complicated (the health IT department was enormous).

    According to the New England Journal's Drs. Mandl and Kohane, the DMCB is not alone. Too many docs today are trapped in legacy systems that don't come close to the home technology they and their patients have, like Twitter, smartphone apps, Facebook, Google search and iTunes.

    They argue that the solution is to reject the  EHR vendors' argument that health care IT has to be complicated.  We can transition from those horrid meaningful-use addled single systems to a flexible modular approach based on cheap and existing technology that is available today.  We need EHR systems that can not only document, order and bill, but:

    1. Reasonably securely store retrievable patient data on the "cloud"

    2. Enable providers to securely share information seamlessly using open source formatting

    3. Apply project management software to patient documentation to record extended interactions over an episode of care

    4. Use public domain analytics to identify, manage and follow population-based care needs

    The DMCB agrees and sees an opportunity that parallels what happened when electricity was introduced to U.S. manufacturing.  According to Drs. Jones, Heaton, Rudin and Schneider writing in the same issue of the Journal, swapping electric motors for steam powered engines during the Industrial Revolution didn't result in any productivity gains. Rather, it was the follow-up distribution of small motors throughout the factory floor that transformed American industry. 

    The same principle may apply to health care. We have yet to intelligently "distribute" information technology in a modular fashion throughout the clinical factory floor and adapt our old one-patient-at-a-time workflows to really take advantage of it.

    Image from Wikipedia

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