“The Complete Electronic Medical Record” - What will “Complete Integration” require from a Service Provider?
Observation
As we enter the next decade, it is interesting to reflect on where the leading healthcare provider and payer organizations were in 2000 and what has been accomplished to solve the evasive dilemma of creating a truly integrated Electronic Medical Record (EMR) that can provide a complete picture of an individual’s health available on demand.
In the 1990s most of the world became familiar with and began using ATM machines to give us access to our financial data and also to provide cash resources. Now it is 2010 and the healthcare industry leaders are still embroiled in the definition of the EMR and implementing a complete one merely within a single Integrated Delivery Network (IDN), much less having global capabilities. The complicated nature of healthcare organizations and their focus on decisions by diverse committee creates politics that struggle to agree on definition and rules necessary for complete integration.
Solutions
Many organizations have completed the first and most costly step which is implementing the software that is capable of hosting the basic functionalities for entering and tracking data to perform clinical workflow, financial, billing and decision making functionalities. Now we are entering the next steps which include;
Optimizing the implemented Product;
Warehousing Data;
Applying Business Intelligence Tools for researching operational efficiencies, improving quality, safety and development of new techniques and protocols;
Medical Device Integration of data directly to the EMR;
Interoperability that allows for accessing data wherever it exists and creating on demand views (EHR, PHR, P4P, EPM);
Compliance for Regulatory and Safety standards’
On going support and maintenance for Clinical and Financial applications.
Conclusion
The requirements for a true integrator will require the provision of service solutions that can leverage leading edge solution sets from internal and external sources. The understanding of the clients needs is paramount, shaping the solution that leverages horizontal services, Centers of Excellence (CoEs) and creatively teaming with leading edge organizations that provide domain specific products as a part of the overall solution set. This allows “World Class” healthcare organizations to depend upon a “World Class” Tier One integrator to supply all of its technology needs. These are necessary requirements for a “World Class” provider of services to compete in the next decade.
Comments
The single most significant element in HIT is, and must continue to be, the physician.
By the very nature of the profession, the physician is the most highly educated/trained provider: only a physician sees new patient problems, admits patients to the hospital, orders tests, reads the tests, orders Rx/treatments/surgeries, performs invasive procedures, and discharges patients.
Physician resistance to EMR has not been because physicians are Luddites, but because they efficient and intimately understand the practice of medicine.
They, better than anyone else, also understand “data overload” and how it can confuse and slow the delivery of patient care.
Example: if I go see my PCP because I have had a sore throat for a week, does the PCP really need my entire life medical history including that for the last 3 years in January I have had strep throat? How does that help, especially if I now have esophageal cancer? Does having every ECG and B/P I have every had on file in a data warehouse help my treatment/outcome?
So, “What are the requirements a true integrator will need to provide service solutions that can leverage leading edge solution sets from internal and external sources?”
• Respect for, and a total support of, the medical practice of the physician
• A viable financial model, especially if the application involves a private physician: $1 a hospital spends reduces the managements’ salaries by $0; $1 a private practice spends directly reduces the physician salary $1 pre-tax. There must be a true financial ROI for the physician, the health system, the payers and the patient.
• Health statistics MUST be mastered: what data (if any) in a patient record are discrete variables? For the 90%+ of patient data that are continuous variables, probability density functions that are determined will yield cumulative probabilities, NOT discrete answers of “this patient has XXX, instruct robot to administer YYY”.
• Respect for and understanding of complex, critical workflows: the physician does not work alone, but in an extremely complex, diverse, and hightech environment. A HIT system cannot drive the patient care process anymore than a computer system can manage NYC (just having all the traffic signals in north Metro DC on one system recently caused a 2 day nightmare).
Posted by: Marshall Maglothin | January 10, 2010 10:32 PM
Gary,
I should note that I am a very successful early adopter of HIT in the areas of digitalized imaging, hospital department LANs, and EMR.
I was recognized nationally by GE Medcial in 2001 for bringing up the northern 2/3rd of Maine's outpatient cardiolgy patients to EMR, and the practice I was CEO of in northern Virginia had over 250,000 cardiolgy patients on EMR. I am also a Sr Consultant with MedAxiom, a virtual thinktank for the nation's 200 largest cardiology practices.
That is to say, I am a 100% supporter of EMR (I have been attending all of the HITECT committee meetings here in DC); however, EMR is not going to improve healthcare outcomes anymore than taking banking information eletronic improved the financial net worth of bank account holders.
Be well,
Marshall
Posted by: Marshall Maglothin | January 11, 2010 07:55 AM