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."
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