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Going On Record: Electronic Medical Records Could Be Transformative

  • David Levin, MD

 One of my favorite expressions is: “Every day I work in healthcare, and then I go home and live in the 21st century.” It is an exaggeration, of course. After all, medicine is incredibly sophisticated when it comes to diagnostics and treatment. Where it has lagged is in the use of information technology (IT) in general and electronic medical records (EMRs) in particular.

The current state of EMRs in the United States is probably best understood as a parallel to the history of the automobile. Finally, we are giving up paper records—our version of the horse and buggy—and replacing them with the current Model T generation of EMRs. This recent adoption is largely spurred by federal incentives and penalties: Early adopters gain financial rewards, and in later stages, penalties in the form of reduced payment for services will kick in. We all hope EMRs will improve quality and allow better coordination of care over time and across the healthcare continuum.

Beyond that, EMRs have enormous potential to collect clinical data that will lead to better decisions and treatments and improve efficiency. Predictive analytics can spot patients who are getting sicker now or are likely to do so in the future, allowing for earlier interventions. We are beginning to leverage these analytics, and it will move even faster as we grow increasingly mobile. Not only will physicians be able to access and share information through smartphones and tablets, but patients will be able to address their needs online, such as refilling prescriptions and asking simple questions. More advanced versions of digital portals even permit remote e-visits.

Perhaps one of the most exciting aspects to the digital revolution in medicine is the variety of devices and sensors that will be able to connect with the EMR. These devices will be around us and in us: Smart insulin pumps, cardiac and gastric pacemakers, or smart replacement joints will provide a constant stream of data that, in turn, can guide changes in diagnosis or therapy.

An example of this Cambrian explosion of mobile devices is the smart scale. A patient steps on it, and his weight is recorded and transmitted wirelessly to a central location and directly to his EMR. This may be one key to addressing a complex and very expensive problem: patients with heart failure who are repeatedly admitted to the hospital. Rapid weight gain often signals worsening heart failure, but the traditional approach of asking patients to monitor their weight has not been particularly reliable or scalable. This central monitoring allows analytics to be applied to that one patient or to thousands of patients at once.

Has this new clinical IT made healthcare better, cheaper, more satisfying? The results have been mixed. These are complex systems being implemented on top of already complex processes. Too many organizations do not take the time to think and act strategically, and they do not redesign workflow to take advantage of the new tools. Technically, the new EMR systems are first- or second-generation software, so there is still room for maturation, and many lack true integration. For example, the software used in the hospital may not work well with software used in a physician’s office. But there is no doubt that IT is a key enabler of the future transformation of healthcare.

Think of it this way: If you wear eyeglasses, you don’t look at the glasses, you look at the world around you. Great technology is like that—it recedes into the background. When that time comes for medicine, we will have made a marriage of high-tech and high touch.

 

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