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The Point of Care: Beyond EHRs and Silver Bullets

 In my early days as a medical student, the promise of electronic health records (EHRs) was all the rage. In some circles, it was all some researchers, IT leaders, and clinicians could talk about. These enthusiastic conversations touted EHRs as a way to improve clinical decision support, centralize patient information, reduce administrative costs, and share information across health systems (among other reasons). Some saw this new technology as the silver bullet that could help fix health care.

In the years since, the medical community has matured in its understanding of what EHRs can and can’t do. We have experiential recognition of how difficult and expensive EHRs are for some physicians, particularly those operating out of small, community practices. Through the debates about Health Information Exchanges and progression through Meaningful Use criteria, we have also seen the kind of challenges that can occur in trying to share medical information across health systems.

So while EHRs definitely have very important and obvious roles in patient care, longer-term success will require other initiatives. Through a presentation at this past year’s IHI National Forum, David Classen – an Associate Professor of Medicine at the University of Utah and Senior Partners and Chief Medical Officer at Pascal Metrics – discussed some ways that we can do this as a community. I’ve highlighted a few of his ideas with a few accompanying thoughts.

Invest in business intelligence. In contrast to our investment in EHRs, we have invested less in predictive modeling and artificial intelligence that can help health systems manage their patient populations. This must (and is already) changing. At this year’s Partners Healthcare Connected Health Symposium, several session panelists from consulting and technology companies discussed the growing shift in focus away from patient care episodes towards patient journeys – the idea that each patient will have different sets of touch points within a health system based on individual needs. To understand these needs and appropriately allocate resources, health systems will indeed need to pursue more robust business intelligence systems. Still, to be useful to frontline physicians, these systems will need to ‘adjust for’ the human element of illness and suffering. We need granularity in understanding patient encounters, but there can always be too much of a good thing.

Aim to give e-power to the patient. Digital technology is allowing for a rapid democratization of health records. Today, patients are taking on more and more active roles in managing their own health. Classen re-iterated this positive trend by describing a transfer of power from provider/institution to patient. He highlighted and suggested the promise of technology for remote biometric data feedback, in-home sensors, social networks, and telemedicine. However, I would have liked to hear more about best practices, top performers, and other quality measures. As the market is flooded with different vendors and legions of new widgets, clinicians will want to know which options are best for their patients – not just in terms of ease of use, UI/UX, or data presentation, but also better outcomes and tangible health benefits.

We’ve grown as a community since my medical school days, in part through a collective realization that one-size-fits-all EHRs will not provide answers to the challenging questions facing health care. As such, pursuing a fuller spectrum of solutions and endpoints – including more business intelligence and patient empowerment – is a challenging, but worthy, effort.

Nonetheless, we should forge forward thoughtfully, careful not to excitedly place our hope in the newest, slickest innovation that claims to improve care (particularly since all of them seem to). Instead, we should utilize the lessons we have learned thus far from EHRs and soberly assess each new innovation. Only then can we remain objective among the myriad of new technologies marketed to improve health, separating real solutions from the promises of new, would-be silver bullets.

You can connect with Josh Liao, MD, on www.medstro.com.

Joshua Liao

Joshua Liao

    Joshua is passionate about using medical innovation to change how healthcare is delivered and to improve overall health. He is currently a resident physician at Brigham & Women's Hospital and a Clinical Fellow in Medicine at Harvard Medical School.

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