Oscar Wilde once wrote that “Everything popular is wrong,” and I think that time has come for healthcare information systems. Now, granted Health information technology (HIT) has come a long way from its infancy as a means to produce a bill. As the use of EHRs expanded beyond basic clinical information and began to encompass greater volumes of medical-data applications for individual specialties and departments — such as radiology, laboratory and pharmacy — arose. With hospitals maintaining a growing repository of patient information, it soon became a vehicle for documenting and reporting a patient’s medical and treatment histories digitally, rather than on paper. As a result, the EHR (née EMR) was born.
The adoption of the EHR by the healthcare industry-at-large has not been without its challenges and a surprisingly low number of providers use the technology even today. Federal initiatives and financial incentives as part of ARRA and Health Care Reform Legislation are expected to drive greater use. Despite slow adoption, EHRs have evolved from simplistic tools that only recorded episodic instances of care. Recent advancements include higher levels of functionality, such as clinical decision support, benchmarking tools and analytics. These however are rarely integrated in the EMR, and continue to require an advanced skill set, (i.e. a report writer), to retrieve information.
And while it’s true well-developed products can interface with other clinical information systems and medical devices that populate a patient’s medical record with critical data, the adoption of this technology is equally slow, due in part to high cost and lack of data standards.
Without a doubt, EHRs play a vital role within our traditional healthcare delivery model, characterized by independent physician practices and well-defined care delivery systems. As the pace of change has accelerated, however, we have to question how well the EHR — as a stand-alone information silo lacking longitudinal context — is able to handle the demands of coordinated delivery models. It’s time to forget and rethink the model.
Emerging multidisciplinary models of care offer the promise of higher quality for patients and reduced costs for the healthcare industry. These new approaches – including patient-centered medical home (PCMH) and accountable care organizations (ACOs) – harness the power of collaboration among primary care providers, specialists, hospitals, health systems, payers and patients to deliver focused, effective and coordinated care.
To fulfill their promise, however, these models require a different toolset than traditionally has been available to the healthcare market. EHRs, while evidence of technological progress in the industry, were designed to support a provider- and hospital-centric approach to care. As such, they are not fully equipped to catapult the industry towards the collaborative strategy preferred today. ACOs, PMHCs and other approaches will rely upon a platform that facilitates collaboration beyond the enterprise and across the community to achieve multidisciplinary care coordination.
For this to work, Information Systems will require new technology solutions to flourish. Current EHRs simply are not designed to operate successfully in this environment. While highly effective at collecting and storing patient data – and providing specific information to help clinicians address episodes of care – EHRs have limited capacity to provide a complete view of the patient to a group of dispersed caregivers where and when required. As a result, there are great volumes of patient data residing in hospital health information systems repositories and provider offices that are not being leveraged.
Multidisciplinary, coordinated care depends on solutions able to translate data and facilitate collaboration. Communication among caregivers associated with multiple disciplines is perhaps the greatest need. In addition to the actual tools required to facilitate caregiver interaction, processes (who, what, where, when, how) must be well-designed and implemented. Efficient protocols are crucial, especially if a patient is receiving care from multiple providers where harmful drug interactions may become an issue.
Personal health records (PHR) need to be recognized as important tools to involve patients. Patient-set security controls should allow individuals gain access to the system to submit demographic and insurance information, to receive lab results and treatment updates, and to explore diagnostic and therapeutic options. How much more valuable is this functionality when it integrates information from all care team members? In addition, the result is we start to add context to the delivery of care.
Coordinated care solutions likewise generate alerts and notifications to help providers and patient better manage their care. Providers automatically are reminded if patients are overdue for routine tests…or have overlooked a preventive service…or failed to fill a critical prescription. Patients, too, can receive these notifications and therefore stay on top of their wellness or disease management programs.
Connected patients doubtlessly can lead to improved care – and therefore improved health. But this level of one-on-one information can also be expanded for added value. With greater degrees of data available, members of the care team not only get a more comprehensive view of an individual patient, but can more accurately assess patient populations as well. This level of information has never been available to clinicians prior to EHRs. Now the clinician has the ability to explore the care he or she provides and can look at aggregate data to improve the level of care. By closing the technology gap left by EHRs and HIEs, providers and payers can see not just the trees, but the entire forest – enabling more effective disease management. Now isn’t that a change!