EHR’s Influence on Practice of Medicine

I recently met with Ensocare to talk about healthcare and healthcare IT and what they saw happening in the industry. We had a far ranging talk about what was happening. However, one thing they said has really stuck with me and caused me to ponder a lot on where we’re at with EHR, where we’ve come from, and where we’re going. Here’s what they said (per my notes):

EHRs were never designed to influence the practice of Medicine.

Thinking about the history of EHR, I concur with this statement. EHRs were designed to better bill for the care you provide. That was their initial purpose. Many were designed to replace the paper chart. Others were built to meet the government meaningful use guidelines. How many were designed to really influence the practice of medicine? Very few if any.

Before we give EHR vendors a hard time, let’s be really honest about the EHR industry. We as the users wanted the EHR to improve our billing or to help us get meaningful use incentive money. We didn’t hold the EHR to the standard of really influencing the practice of medicine. The EHR market gave us exactly what we asked for. We can’t blame EHR vendors for meeting our market demand.

Why then are we surprised that EHRs don’t improve care, when they were never designed to do so?

With this baseline history, I’m not sure this is going to be enough going forward. Now that EHR software is implemented, many have the hope that the EHR will influence the practice of medicine. I’m interested to know how many EHR vendors will be able to create features, functions, workflows, etc that influence medicine versus something from outside the EHR vendor doing it. My guess is that the majority of EHR innovations will come from outside the EHR software itself. Many will work with the EHR data to achieve the result, but it will be someone from outside the EHR vendor that creates the result.

To me, this is the potential of EHR which has yet to be realized. What do you think? Will EHR be able to influence the practice of medicine? Will organizations, companies and individuals be able to build on the top of the existing EHR to influence medicine? Or will we need a new crop of EHR systems that are designed to influence the practice of Medicine? I look forward to hearing your thoughts in the comments.

About the author

John Lynn

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

4 Comments

  • Hello, John. I enjoyed reading your article. I must say I don’t 100% agree with your statement of “Why then are we surprised that EHRs don’t improve care, when they were never designed to do so?”. Working for Cerner for the last 7 years, has given me a lot of experience with how our EMR has evolved. Today we have a number of functionality that DOES improve care. This is not a sales pitch, but fact.

    For example, we have a proprietary algorithm for Sepsis prevention. With the data in the EMR, our system will check for signs of the onset of Sepsis. Then alert the care provider of the situation and then suggestions on what to do next. Obviously it is up to the nurse and doctor to carry the actual care out, but without the EMR, many cases are not caught in time. And with Sepsis there is only about a 6 – 8 hour window before the patient goes into organ failure and there is no point of return. So, for me the EMR must definitely provides improved care. One of our clients in Spain had their mortality rate drop 32% in the first 4 months after implementing our Sepsis solution.

    There are many other examples, such as device integration (drastically reduce human errors), VTE/Falls/Bed Sore prevention..etc.

    I hope that was not too long of a comment! 🙂

    Take care,
    Jerry

  • Jerry,
    Thanks for reading and joining in on the conversation. Glad to have you around. Plus, your comment is about average, so you’re in good company.

    I think the subtle difference in my post and what you said is this. EHR can and even does improve care in ways like you describe. However, in most cases I’ve seen, that wasn’t the reason that the EHR was created and more importantly, it wasn’t the reason that it was purchased.

    I do believe that this shift is starting to happen. I allude to that at the end of the post. I think we will start seeing more and more organizations that desire IT that does influence the care they provide and they’ll be willing to pay to have it.

  • John,

    The EMR I used a bit as a teenage volunteer back around 1973 in a Northeast PA hospital was clearly meant to help with accurate billing. Everything ordered for a patient went into it once the patient was ‘admitted’ via the system. But the neat thing at the time; orders (under normal conditions) were not phoned or faxed or walked to the area carrying them out; they came through the system, quickly and accurately (as accurately as they were entered), with no room for misunderstood writing. They left a very accurate record of orders, which most certainly helped with quality control and efficiency. And better accuracy helps with patient care, though sometimes indirectly. And it also protected the patient and insurers against charges for orders never given. Pretty good for 40 plus years ago.

    Ron

  • John, I couldn’t agree with you more. Most physicians are struggling with EHRs precisely because the systems were not designed for patient care or with physicians’ workflow in mind – which is why EHRs typically cost physicians time out of their day. Creating inefficiency for the most expensive asset in the healthcare system (physicians) is completely unacceptable; and failing to leverage computers to improve patient care is an opportunity lost. That’s why companies “outside the EHR vendor” (like PatientKeeper, where I’m CMO) have a great opportunity – because applying IT to actually save physicians time and qualitatively improve their clinical decision-making will truly benefit patients, clinicians and hospitals.

    – Donald M. Burt, MD, Chief Medical Officer, PatientKeeper Inc.

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