Nearly all healthcare organizations in the United States, the United Kingdom, and other countries have transitioned to “meaningful use” of electronic health records (EHRs).
Unfortunately, compliance with federal mandates, at least in the United States, is not the same as return on investment (ROI): To measure the real payoff from this investment, we need to evaluate how we have improved the overall health and care of patients. And the truth is, we still have some work to do.
That is not criticism, or even a surprise. Most innovations take years to “shake out” — to take hold in widespread and productive ways. For example, take penicillin: Fourteen years passed between Alexander Fleming’s discovery and the drug’s first use with a patient. Many more years passed before it was adopted for widespread medicinal use. Similarly, with EHRs, we are still some ways away from completely leveraging them, and the revolutionary effects yet lie ahead.
I see this digital transformation of healthcare in three waves. The first wave was getting off paper to a digital format, and the second is connecting digital information across the network. The third wave, and for me the most exciting, is where we apply powerful analytics and computing to the networked digital information.
Getting medical records off paper into a digital format was a formidable first step toward healthcare innovation. But, digitally connecting all of the information is not enough. Today’s EHR is not an end-all solution to improving patient care; it simply opened a door.
The good news is that we’re talking about a ‘barn door.’ The possibilities are huge, and they include sweeping, generational advancements in population health. By combining massive amounts of information with advanced analytical tools, we can change how we recognize, understand and fight diseases.
Let’s connect
Moving from a paper-based system to a digital system was a major advancement: To improve lives and health outcomes for individual patients and for large health populations alike, however, we need greater connection.
Patients who need the most care — like those with chronic conditions — typically see more than one physician. Their medical team may cross several health systems or networks, each with its own digital record. For example, Emergency Department visits typically do not sync up with regular appointments, specialist visits or every lab result. As long as medical information remains siloed, patients will not realize the true benefits of digitization. Currently, their medical picture is clickable and perhaps searchable, but it’s not complete.
The next step is to connect disparate EHRs so each patient’s medical history is available where it is needed, wherever that may be. In the second wave of healthcare innovation, I envision a virtual pool of data, where medical teams and patients can contribute and extract information at will.
I recognize there are barriers to creating these virtual pools of data. Some barriers are technical and more are business related. Many organizations have business reasons to NOT share data; they see patient information as the connection to the patient and the revenue generated caring for that patient. Patients and society are also concerned about privacy and security.
Admittedly, the solution isn’t simple — but it’s not impossible, either. First, we need to recognize sharing as the right thing to do for patients. Once we’ve accepted patients’ best interests as our guidepost, I’m certain the business issues can be addressed and technology can accommodate the requirements.
I challenge practitioners to expand our definitions of “coordinated care” and “collaborative treatment.” Let’s figure out how to use technology across populations, not just medical practices. I believe collaboration and connectedness will deliver groundbreaking improvements in population health while paving the way for critical insights in research.
Prescribing meaning
Isolated sets of information have limited use. But pool them together, and we have something quite powerful. In the third wave of digitization, EHRs will begin to yield insights, not just information.
With access to larger bodies of information about a disease and how it progresses, physicians can draw better conclusions about how to not just treat, but also prevent illness. It’s so powerful to expand your sample set from a few hundred to a few million.
At a large scale, we can apply powerful computing techniques like machine learning and artificial intelligence to derive powerful insights and improve clinical guidelines. And, patient data is just one input. We have the capability to collect and analyze information from a range of sources – from online search trends and wearable devices to pharmacy purchasing. Pooled together, better information will lead to better decisions and outcomes.
In fact, we can potentially decrease the number of people acquiring chronic, preventable conditions like diabetes. By flagging markers of high risk — and possibly discovering new ones — we can move from intervention to prevention. By using data, we can change the course of disease and keep people well.
The next technological innovations in widespread population health probably won’t come from new surgical techniques. Instead, they will come from better-informed decisions. Data-driven medicine will change lives for generations of patients while aligning with digital-era expectations for care.
New tools of the trade
Digitized records are merely a tool. This tool must be combined with people and well-informed clinical guidelines in order to be effective. All three components are critical if we are to advance medical outcomes.
Our job, then, is to inform the best possible guidance and to arm patients and our fellow providers with information, at the right place and time. The combination of technology, people and clinical guidelines will make the biggest difference in population health.
The patient will see you now
We can’t ignore that we live in a digital world — nor what “digital” means to patients. Guess what? For patients, “digital” has little to do with being paperless. Digital patients are connected, well-informed and highly engaged in their care.
Today’s patients expect their medical team to have a holistic and up-to-the-minute view of their health: “If my financial institution or entertainment service can maintain an accurate digital status for me, why can’t my healthcare providers?” As consumers, patients have high expectations; they have a digital lifestyle — and they expect it to extend into their healthcare.
So I am optimistic that these waves of digital transformation in healthcare will lead to improving health and healthcare for our citizens and patients. This improvement will be the return on investment of monies, productivity and administrative burden on physicians and healthcare providers. Technology can and will deliver the right information and insights to the right person at the right time and place. This is better information for better decisions for everyone: patients, doctors, hospitals, governments, payors and researchers — leading to improved health outcomes and saving money.