Here’s an argument that’s likely to upset some, but resonate with others. After kicking the idea around in my head, I’ve concluded that given broad cultural trends, that the healthcare industry as a whole has outgrown the use of paper records once and for all. I know that this notion is implicit in what health IT leaders do, but I wanted to state this directly nonetheless.
Let me start out by noting that I’m not coming down on the minority of practices (and the even smaller percentage of hospitals) which still run on old-fashioned paper charts. No solution is right for absolutely everyone, and particularly in the case of small, rural medical practices, paper charts may be just the ticket.
Also, there are obviously countless reasons why some physicians dislike or even hate current EMRs. I don’t have space to go into them here, but far too many, they’re hard to use, expensive, time-consuming monsters. I’m certainly not trying to suggest that doctors that have managed to cling to paper are just being contrary.
Still, for all but the most isolated and small providers, over the longer term there’s no viable argument left for shuffling paper around. Of course, the healthcare industry won’t realize most of the benefits of EMRs and digital health until they’re physician-friendly, and progress in that direction has been extremely slow, but if we can create platforms that physicians like, there will be no going back. In fact, for most their isn’t any going back even if they don’t become more physician firendly. If we’re going to address population-wide health concerns, coordinate care across communities and share health information effectively, going full-on digital is the only solution, for reasons that include the following:
- Millennial and Gen Y patients won’t settle for less. These consumers are growing up in a world which has gone almost completely digital, and telling them that, for example they have to get in line to get copies of a paper record would not go down well with them.
- Healthcare organizations will never be able to scale up services effectively, or engage with patients sufficiently, without using EMRs and digital health tools. If you doubt this, consider the financial services industry, which was sharing information with consumers decades before providers began to do so. If you can’t imagine a non-digital relationship with your bank at this point, or picture how banks could do their jobs without web-based information sharing, you’ve made my point for me.
- Without digital healthcare, it may be impossible for hospitals, health systems, medical practices and other healthcare stakeholders to manage population health needs. Yes, public health organizations have conducted research on community health trends using paper charts, and done some effective interventions, but nothing on the scale of what providers hope (and need) to achieve. Paper records simply don’t support community-based behavioral change nearly as well.
- Even small healthcare operations – like a two-doctor practice – will ultimately need to go digital to meet quality demands effectively. Though some have tried valiantly, largely by auditing paper charts, it’s unlikely that they’d ever build patient engagement, track trends and see that predictable needs are met (like diabetic eye exams) as effectively without EMRs and digital health data.
Of course, as noted above, the countervailing argument to all of this is the first few generations of EMRs have done more to burden clinicians than help them achieve their goals, sometimes by a very large margin. That seems to be largely because most have been designed — and sadly, continue to be designed — more to support billing processes than improve care. But if EMRs are redesigned to support patient care first and foremost, things will change drastically. Someday our grandchildren, carrying their lifetime medical history in a chip on their fingernail, will wonder how providers ever managed during our barbaric age.