Healthcare // Electronic Health Records
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4/5/2013
11:36 AM
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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.

Interoperability between disparate EHRs is still largely lacking. Many observers believe that the problem is lack of standards or poor implementation of those standards, but Simborg disagrees.

"The real problem with interoperability is not standards," he said. "We've got more standards than we can deal with. The problem is the buyers of healthcare -- the hospitals, the big healthcare organizations, the integrated delivery networks. Once they see it's in their economic interest to demand that the vendors be interoperable, that will change things. But so far, they haven't done that."

Simborg also believes that clinical decision support needs to be rethought to get widespread physician adoption. "Physicians resist decision support. They hate getting alerts and reminders; in fact, they get so many of them they ignore them. So this is a usability problem. How do you deliver this knowledge to physicians at the point of care?"

The right way to do it, he said, is to provide the decision support in ways that reduce the amount of work for physicians. For example, an "intelligent system" could use clinical protocols to enter default orders that the doctor could approve, which would save him the time required to input those orders himself.

Regarding the prediction in his article that CDSS will start to emphasize genetic data, Simborg agreed with other experts who recently observed that EHRs aren't designed to use genomic information and don't have sufficient storage capacity, in any case. He believes that EHRs will have to change to accommodate this data and that they will in the next five years.

The distinction between telemedicine and EHRs will blur, he said, because "more and more medicine will happen through the Internet. Lots of healthcare will happen without there being a physical encounter, and the EHR will have to cope with patient inputs a lot more. So we won't call it telemedicine anymore."

Regulatory requirements dominate, our research shows. The challenge is to innovate with technology, not just dot the i's and cross the t's. Also in the new, all-digital The Right Health IT Priorities? issue of InformationWeek Healthcare: Real change takes much more than technology. (Free registration required.)

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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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