Thursday, March 7, 2013

Why Haven’t Electronic Health Records Made Us Healthier

Fact: Before the web about 20 years ago, roughly 4,000 people from 200 companies congregated in San Diego for a conference to talk about the future of health-care information technology.  This was long before the technology of the WEB begins, when computers in physicians’ offices were used only for scheduling and billing patients and paper charts bulged out of huge filing cabinets.

It was one of HIMSS’s or Information and Management Systems Society’s first big conferences.  Several physicians, technologists, visionaries, engineers and entrepreneurs shared one idealistic goal, a goal to use information systems and technology to fundamentally change health care. The intention was not just to improve the old system but a future that looked a lot like we were being promised throughout the economy as it sped into the Internet era.  The aim is for the computers enabling improvements in the practice of medicine to make it safer, higher quality, more affordable and more efficient, all in for one same goal, to make the people healthier. A company that was called Allscripts was then built not long after the said conference.  Its focus was electronic prescriptions.  The old joke about impossible to read doctor’s handwriting was after all no joke, because according to The Institute of Medicine, about 7,000 Americans were dying each year from paper prescription errors. The first fully electronic prescription using Allscripts system was transmitted by an innovative physician named Azar Korbey of New Hampshire.  As of today about 600 million prescriptions out of 1.5 billion in the U.S. are written electronically, this is according to industry source SureScripts.  This is a considerable development but there is more to do but it is safe to say electronic prescribing is saving lives.

Rivals have a common goal, Allscripts, Cerner and Epic, to make all physician practices and hospitals digital.  So the next phase was electronic health records.  These competitors found ways to automate a complicated clinical encounter. The goal seems didn’t seem to be unattainable although putting PCs on every desk was only the first step in the information revolution.  And it all started when these PCs were then connected to the Internet and developed “apps”, everything changed.  Consider Amara’s Law: “We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run.”

The whole process has been hard, from zero to getting nearly half a million physicians using electronic records, required a tough effort.  Rewording Churchill, this is not the end. It is not even the beginning of the end. But is it, perhaps, the end of the beginning of the electronic health revolution. There had been many critics and disbelievers trying to knock the value of the investments in the system, pass judgment on the government’s stimulus, and doubted the return on investment.  An open letter to president Obama by David Kibbe, a physician and technology advisor to the American Academy of Family Physicians, says that electronic health records are “notoriously expensive” and “difficult to implement.”  Disagreeing about subsidies, Kibbe wrote: “Nor is there conclusive evidence that the use of EHRs improves patient care quality.” More people now understand that making digital records work is critical to fixing health care.  The annual HIMSS conference held last week in New Orleans is expecting 35,000 people and 1,000 vendors to focus on that task.

“The impact of IT on health care over the past decade has so far been modest,” this is concluded by the President’s Council of Advisors on Science and Technology concluded in a recent report.  The key words: so far. Investors and the industry would be wise not to underestimate what’s coming. It is nothing short of an explosion in innovation and creativity, facilitated by open systems and connectivity. The technology can fix itself; this is was what the council has found out. “The ability to integrate electronic health information about a patient and exchange it among clinical providers remains the exception rather than the rule,” this is what the report saying right now and this is exactly what need the change. The job on getting all the physicians on board is still on going, while the CDC reported in December that 73% of physicians now use electronic health records, up from about a third two years ago.  This means a great progress yet there are still many physicians using paper. Next step is to get all the records connected to each other, this means the industry, through HIMSS and the government, through the Office of the National Coordinator, are pushing for interoperability. For the time being, the existing systems that were already installed needs improvement.  This is because they are not user-friendly, and this claim is from someone who spent 15 years developing and selling them.  With the development of the new iPad and other mobile apps, this will help the industry to do better and it will.  Electronic health records today tend to be “information retrieval” tools and we have to vitally change it.

Human health will be improved once records are open, connected, and more user-friendly, we can start to add intelligence to the network that will help doctors, nurses, care coordinators and patients all do a better job. Health care in next to no time will be overflowing with similarly exciting start-ups producing apps that alter everything.  We actually see it is starting to happen; ground-breaking companies like dbMotion are linking dissimilar systems across health care organizations.  Other innovators, like Humedica recently acquired by OptumHealth, they are learning how to mine data for insights that will help physicians and care coordinators keep track of large panels of patients. Medical apps that dial into electronic health records at last are starting to be seen everywhere. This will impact cost and quality in very significant ways like an example is a wireless scale can notify a nurse when a congestive heart failure patient gains weight indicating dangerous fluid retention.  Or just look how convenient this will be, wearing a device that allows your vital signs to be remotely monitored all the time, rather than at a once-a-year doctor visit. “Technology, properly applied, is indistinguishable from magic.” It is the “applied” part of that dream we are still working on. But I’m confident we’ll get there. A connected system will help patients take responsibility for their health. Strong teams of physicians, nurses and caregivers will use an intelligent network to make their results better and their jobs easier. It does sound like magic. And we are getting closer each year. Just take a walk around HIMSS and you’ll see the future.—Arthur C. Clarke

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