The Elusive Promise of Electronic Health Records
The Electronic Health Record Outcome: The Dream and the Reality
Electronic health records systems are far from delivering better healthcare. Design focused on better usability and patient outcomes can help.
The promised outcome of digitizing paper-based electronic health records (commonly and interchangeably referred to as EHR and EMR) was that it would make health care cheaper and more efficient. By making records digital we would be able to share them with different caregivers in a patient’s care network, creating a holistic approach to care and better outcomes. Studies concluded EHR adoption would lead to better preventative care and chronic disease management.
..In 2009, largely as a result of this kind of analysis and lobbying by EHR industry executives, the Health Information Technology for Economic and Clinical Health (HITECH) Act appropriated $35 billion to incentivize and promote the use of health information technology by physicians, hospitals, and other health providers...Yet several years later, the projected benefits have failed to materialize. ...It begs examination of what has been the net benefit of this massive investment. What went wrong, could we have prevented it, and how can we fix it? ..We can easily summarize the root of the problem as a perfect example of the right intentions but the wrong incentives. In order to make sure the investment in EHR was spent wisely, the government came up with some pretty comprehensive standards called ‘meaningful use,’ (MU) criteria... The MU criteria were divided into three important milestones, in Stage 1, targeted at 2011-12, the outcome to be measured was “Data capture and sharing.” Stage 2, slated for 2014 measures outcomes from the perspective of “Advancing clinical processes.” Phase 3, set to start in 2016, finally aims to focus on “Improved outcomes” for patients. ..The first generation of EHR products are nothing more than form-filling interfaces to convoluted patient databases, recording what drugs, treatments and tests have been performed. ..
I am cautiously optimistic that Stage 2 and 3 MU criteria will drive the design of these systems back towards the originally stated clinical and patient outcomes. Every care must be taken to insure that every single feature of a new system is relentlessly focused towards the long-term outcome of the product (healthcare). Yet my concern is that those outcomes haven’t been front and center during the last few years of frenzied adoption. It will take several years to undo the impression amongst caregivers (and patients) that these systems are anything more than a tax to their productivity. ..
This first stage of development and adoption may still have a silver lining. Over 70% of healthcare organizations have adopted EHRs – and for many that technology adoption is irreversible. While the promise of EHRs for better healthcare on the personal level is still elusive, the value of the data collected is starting to bear fruit as more and more big data analytics applications emerge that help with pattern recognition and prevention. Yet, unless we focus on improving individual outcomes for patients, the clear winners will be the big companies whose profits are soaring across the records industry, rather than patients or the caregivers themselves.
The Design Imperatives: Re-shifting the Focus to Patient Outcomes, or, the Power of Thinking Ahead
Next year, hospitals and health organizations will initiate another wave of EHR upgrades that will make sure that they comply with the Stage 2 of the MU criteria. The temptation will be to focus on addressing the clinical advancement criteria, putting off patient outcomes until Stage 3 looms closer. However, a smarter and more forward-looking approach might be to aim for Stage 3 compatibility within Stage 2 implementation.
Read more: http://medcitynews.com/2014/01/elusive-promise-electronic-health-records/#ixzz2rVtlVF9z Read about the The Usability Problem ....At the heart of the usability and design problem is that an EHR system is trying to serve two different masters: the clinical staff or caregivers (users) and the administrators (buyers). The needs of these two constituencies are rarely aligned –caregivers look for ease of use and integration with their very specific workflow, administrators optimize for cost savings and easy billing. The result is a disruption of process and workflow that not only slow clinicians down, but introduces higher risk of human error, as medical professionals admitted to us in interviews. ..
Read about The Design Imperatives: EHR Evolution or Survival of the Most Usable ..In order to future-proof EHR investments, we must build systems with sufficient flexibility to assist in the process of gathering information from various sources at the point of care and beyond. The wearable technology space and the Internet of Things will have a dramatic impact on the quantity of patient data being recorded. In addition, as services built around the Quantified Self movement evolve and begin driving long-term healthy behavior change and helping with chronic condition management, we would need to design systems that empower providers to easily synthesize and mine the data for insights, and that allow for different kinds of doctor-patient interactions. Finally, we must also consider context of use, and focus on improving the patient-doctor relationship in the design, so that the technology supports better human communication – not more efficient human-computer interaction.
A Treatment Plan for EHRs: Outcomes + Usability
While focusing on patient outcomes and usability will each help EHRs deliver on their original promise, working on both simultaneously is the only way to realize that promise effectively and immediately. Focusing simply on usability without improving patient outcomes will make adoption faster, but in a way it will also help us get to the wrong destination faster. And with usability so poor, and doctors spending such a significant amount of their patient time taming the tool, it can be argued that positive healthcare outcomes without usability are impossible.
Read more: http://medcitynews.com/2014/01/elusive-promise-electronic-health-records/#ixzz2rVvrL33k
Very useful and insightful information! Read this, specifically when in the US! Otherwise, pay attention to the learnings and serious advice!
Just what I keep saying all along: Ehealth is not about technology, it is collaborative care for health!