Dugan Maddux, MD, VP CKD Initiatives Fresenius Medical Care North America
Monday, April 21st, 2014
In late March The Atlantic published an interview with David Blumenthal entitled “Why Doctors Still Use Pen and Paper.” This is a great conversation about EHRs and why providers have had a hard time adopting this digital technology. You may recall that Dr. Blumenthal, who has had a career in healthcare policy research and politics, served as the National Chairman for Health Information Technologies from 2009-2011 during the time when the Obama administration stimulus package tossed $17 billion into EHR adoption incentives.
EHR Asymmetry of Benefits
In this interview Blumenthal notes that EHR adoption by providers has been slow in part due to “asymmetry of benefits.” EHRs have been good for some stakeholders like patients who benefit from easier access to records, better continuity of care, and a decreased likelihood of duplication of tests. Providers, on the other hand, have largely seen EHRs as the Evil Empire of cost, workflow disruption, and awkward usability. Not that the dot prompt command isn’t intuitive…
The gist of the Blumenthal interview is that EHR technology and EHR adoption are in the early stage of transition. Other industries have experienced this same gap between the commitment to computerization and increased worker productivity that comes later.
One problem for healthcare is that there is a “broken Medical Marketplace.” The providers who bear the cost of the new EHR technology are not seeing the financial benefit even in the middle term, much less in the short term. Hopefully providers will receive rewards as the healthcare payment system moves to value and pay-for-quality care at an efficient cost. EHRs should play a big role in demonstrating quality care and eventually streamlining data collection and management to create efficiencies that lower the cost of care.
EHR Improvements Needed
The interview highlights some of the most urgent EHR problems to be solved. Front and center is the “ergonomic quality” of the hardware in the clinical setting. Hardware innovation must solve the problem of providers looking at computer screens instead of at patients. There is no question that providers typing in data is a big workflow disruption that hopefully can be mitigated by improving voice recognition technologies.
The EHR Data Mine
While we are still struggling with the efficient use of EHRs as a point of care tool, we are recognizing their value as a powerful data collection tool. Blumenthal points out that EHR digital data contributes significantly to healthcare Big Data, which is beginning to change patient care. According to Blumenthal healthcare analytics will, “…help us take these data and turn them into diagnostic information — into recommendations a physician can give a patient or that patients can get directly, online.”
The Atlantic published a follow up to the Blumenthal interview with some very interesting comments from readers. Of particular note was clarification from a student getting a PhD in statistics who points out that the information and data needed for diagnostic tasks versus treatment tasks are statistically very different. Data that can help with diagnosis is in the “realm of pure prediction.” On the diagnostic side providers need to know what the individual patient is at risk for in order to provide preventive or preemptive care. Analysis of observational data is already yielding Population Data, so that we can provide patients with some risk-of-disease probability based on fitting them into a Population group. On the horizon are robust Predictive Models generated from big observational data sets. Predictive Models will provide high probabilities of risk for individual patients, allowing for customized care for each patient.
This probability of risk data is helpful for diagnosis, but it does not provide treatment recommendations. The best treatments for disease or prevention of disease come from “causal inference,” found in Randomized Controlled Trials and scientific study. In the future, however, “prescriptive analytics,” which use Big Data to predict outcomes based on a particular action and intervention, may provide treatment options. Prescriptive analytics may help you ask, “What will the outcome likely be if I make this choice for treatment?”
No doubt providers remain disappointed and frustrated with the lack of benefit EHR adoption currently provides at the point of care. It’s like living through the bag phone days to get to the EHR smartphone 10 years down the road.
In the meantime, don’t underestimate the value of the data your EHR is gobbling up every day. The Big Data analysts are making sense of it and you and your patients may benefit from Predictive Models and Prescriptive Treatment probabilities in the short term. Think of EHR data as money in your diagnostic bank.
Has EHR adoption added value for you and your patients today?
