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4/5/2013
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Health IT In 2018: Crystal Ball Predictions

Near-universal EHR adoption, genetics in clinical decision support and widespread Internet medicine are all around the corner, says study.

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In a new paper in the Journal of the American Medical Informatics Association (JAMIA), three health IT experts summarize the progress made in the field to date, list the barriers that remain, and make predictions about what will happen in health IT over the next five years.

Donald W. Simborg, Don Eugene Detmer and Eta S. Berner, who forecasted the current explosion of health IT in a 2005 article now predict that by 2018 we can expect:

-- Near-universal adoption of EHRs.

-- Greater emphasis and progress on standards and interoperability.

-- New breakthroughs in user interfaces.

-- An emphasis in clinical decision support systems on genetics and personalized medicine.

-- A resurgence of computer-assisted diagnosis.

-- A better understanding of the strengths and weaknesses of big data.

-- A blurring of the distinction between telemedicine and EHRs.

[ Health IT gets a boost from a popular former president. Read Bill Clinton Stumps For Health IT At HIMSS. ]

In an interview with InformationWeek Healthcare, lead author Don Simborg, a health IT veteran who helped found HL7, said that in 2005, he and his colleagues expected that EHRs would spread rapidly, but only if there was a change in the financial environment. What they didn't expect was that that change would come from the federal government in the form of $19 billion in EHR incentives.

The JAMIA paper cites the serious deficiencies in EHR usability that physicians have encountered. Simborg attributed those problems partly to the fee-for-service payment system, which rewards providers for the volume of documentation that EHRs make possible.

"That's driven a lot of things that make usability ugly: for example, the requirement to do a complete review of systems, along with family history, past history and so forth. As a result, the record is really unreadable and, in fact, unreliable. Physicians don't trust these records that are computer generated by these large templates. So what will change that is a change in the payment system and a greater emphasis on some kind of pay for performance -- the kind of shift we're starting to see, where you don't get paid by documenting eight pages of patient history, you get paid by improving the healthcare of the patient. That will improve documentation as well."

Another usability problem is related to the difficulty of documenting patient encounters with point-and-click templates, he noted. "Doctors are storytellers. They like free text, they don't like dropdown menus, because they don't express enough. So I think we're going to see breakthroughs in natural language processing, which will make a big difference." The area where this is most needed, he added, is in the history of the present illness, which doesn't lend itself to templated documentation.

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4thDimension
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4thDimension,
User Rank: Apprentice
4/10/2013 | 7:57:20 PM
re: Health IT In 2018: Crystal Ball Predictions
I agree in part with Jay's comments. Certainly user acceptance is key to the appropriate use of EHRs. However, the complaints I and my team receive from physicians are in exact alignment with "issues" physician groups have groaned about for years. For instance, the AMA continuously pubilishes "scope of practice" papers for healthcare providers which are not physicians (Pharmacists, APRNs, PAs, etc.). These typically call for tightened restraints on the services provided by the groups they do not even govern. The problem is the MDs don't want to do the work themselves. This is why Pharmacists, for instance, have taken it upon themselves to play larger roles in the proper prescribing of medications for patients; along with the fact medicine in general is so complicated and experts in these subfields are truly necessary for the patient's sake. Physician complaints about "alert fatigue" exactly mirror this problem in many situations. Generally, I dismiss the idea of alert fatigue because it is used far too often as an excuse to shorten the time a provider needs to spend with a patient in the system. There is certiainly the possibility of creating more alerts than necessary, but for our institution as an example, there are few alerts to begin with and even those are routinely ignored by prescribers who simply click the closest button to their mouse cursor and move on. What is really largely taking place is the provider who was unaware of all the work which really goes into filling the scratches he/she puts on a piece of paper are now presented to that prescriber via the electronic record. This is then coupled with the standard reponse from our physician advisory groups to "problems" in the system which typically state, "Can't we create a Best Practice Alert to warn providers of this issue?"
jaysimmons
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jaysimmons,
User Rank: Apprentice
4/10/2013 | 4:56:40 PM
re: Health IT In 2018: Crystal Ball Predictions
I can see all of these things happening by 2018 and some even before that. Interoperability is already one of the hot topics of today, and with all these HIEs popping up we are seeing more of it, and a greater access to it for potential members. EHRs are already being adopted at steady rate, and its only a matter of time before its Gǣnear universal.Gǥ User interfaces may take some time to work out as there is always resistance to change, and change is not always good in some cases, but I think that as more physicians realize that these systems are here to stay, they will try to work with the systems and improve or shape them according to what they want. With big data and a focus on it, we will be better poised to apply it to better patient care, and to make life easier for physicians as well.

Jay Simmons
Information Week Contributor
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