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.