The Electronic Health Record – Where We Are, Where We’re Going

No situation is more devastating to an industry than to be data rich and information poor. Unless we can effectively use our data to get information, then we may as well not even have the data.

There are a variety of EHRs on the market right now – PowerChart, Quadramed, Amazing Charts, SOAPware, to name but a few – and they all do pretty much the same thing – display data about a patient. Essentially, they’ve become a digital version of the paper charts. Sure, they look nicer, are easier to use, and let you quickly find information, but for most purposes, they really don’t do much more than a traditional paper chart does.

So what’s wrong with this picture?

Simple. As an industry, we’re not leveraging the capabilities that a digital platform will allow. Some software packages integrate reference websites like UpToDate or Medscape. But again, this is not providing new capabilities. This is just adding a HTTP link to a digital version of a paper chart.

EHRs these days are what I would refer to as a “dumb display”. That is, they display information, but they don’t tell you anything about it. An EHR can tell you that your patient’s hematocrit is low, or that the potassium is low, or that the patient is having diarrhea. However, it tells the user nothing about the cause of these. It doesn’t intuitively link the fact that the patient may have just received a fluid bolus or is receiving lactulose, which can account for the abnormalities seen.

So where do we go from here?

Again, the answer is simple. The next generation of EHR will be intelligent software. When a patient’s symptoms, medication list, etc. are documented, intelligent algorithms will run to look for associations. Multiple drugs can have similar adverse event profiles, and this new generation of software will be able to automatically link these adverse event profiles to the patients symptoms to help the clinician derive associations.

Differential diagnosis will also be substantially enhanced. How will it happen? Matrix mathematics and logic will be employed to create disease-associated symptom sets that will reference against the patient’s presentation. These will then be mathematically ranked to give the clinician a better sense of what’s going on and to suggest diagnoses that may not have been apparent.

These are but a few examples. The vast majority of data in health care is unstructured. Accessing this information will be no small feat, but technology has been developed to do it, and the technology continues to get better and better.

This may sound like science fiction, but with technology available today, it has become science fact. The future is exciting, and health care is transforming. While traditionally, health care technology has lagged 10 to 15 years behind other industries, the next generation of EHR will finally begin to utilize what technology is best for: rapidly sorting through and managing vast amounts of data to produce information.

I, for one, welcome the new era in medicine. And for those that fear doctors will be replaced, no one is talking about this. Technology will not replace doctors. It will make us more effective, more efficient, and more capable than ever before. It will improve quality and cost-efficiency. It will improve outcomes. And, most importantly, it will be yet another tool in our arsenal to improve our patient’s lives.

And that last goal is worth all the effort.

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