The Future of Electronic Health Records : Vision for 2028
Ten years ago, one doctor in 10 kept digital records on their patients. The other 90 percent made notes on paper and stored them in manila folders on shelves and in filing cabinets.
Paper records had some obvious disadvantages. They took up space, they were difficult to share with other physicians, hospitals, and insurance companies.
Patients switching doctors, hospitals, or places of residence could not easily bring their records with them.
In 2009, in the wake of the financial crisis, the federal government acted to remedy this situation. The Health Information Technology for Economic and Clinical Health (HITECH) Act set aside $27 billion of federal funds to encourage health care providers to adopt electronic health record (EHR) systems, and more money was subsequently made available for training and assistance.
All told, the federal government spent about $35 billion on bringing the U.S. health care industry into the electronic age. The program was highly successful in that it made EHRs commonplace.
Today, nine in 10 doctors have adopted them. “We have made a colossal transformation in a relatively short period of time,” says Lloyd Minor, MD, Dean of Stanford Medicine. “But we have not realised the potential benefits of the data that exist in electronic health records.” Indeed, many of the benefits of EHRs have been elusive.
As implemented today, EHRs have too many of the drawbacks of paper records.
The promise of being able to send them easily from one office to the next has been hampered by a lack of standards and perverse incentives in the health care marketplace to hoard information.
Worse, EHRs, with their cumbersome user interfaces and onerous billing requirements, have become a burden to doctors and nurses, contributing to burnout and information overload among physicians, and degrading patient care. “A clinician will make roughly 4,000 keyboard clicks during a busy 10-hour emergency-room shift,” writes Abraham Verghese, Professor for the Theory and Practice of Medicine at Stanford Medicine, in the New York Times Magazine.
Although EHRs have many problems, there are reasons to believe that they will eventually start living up to their promise. With some changes in technology, regulations, and attention to training, EHRs may soon serve as the backbone of an information revolution in health care, one that will transform health care the way digital technologies are changing banking, finance, transportation, navigation, Internet search, retail, and other industries.
Regulations are being put in place that will put patients in control of their own health records and facilitate the sharing of data among health care organizations. Engineers are developing artificial intelligence technology that can “take notes” for physicians, summarize the important points from a patient’s record, and assist in medical decision making.
Apple’s recent app for medical information, which gives third-party developers the ability to pull information from health records, is expected to be the first of many developments that brings health care data to patients’ fingertips.
“There are a lot of reasons to be optimistic that we will be able to have both high-tech and high-touch medicine,” says Minor.This white paper is intended to provide a roadmap for this transformation. We will explore the current state of the EHR, reporting the results of a survey by Stanford Medicine and The Harris Pollof physicians and their experiences and attitudes with EHRs.
Most important, we will offer some concrete suggestions for solving the problems that physicians confront today with regard to EHRs and how the medical profession can fully leverage the power of medical data over the next decade.
We will distill the key ideas from a symposium of health care industry professionals, hosted by the Stanford University School of Medicine on June 4, 2018, including a vision of how EHRs could contribute positively to health care and medicine by 2028, how to exploit the best ideas from the tech industry to make it happen, and immediate and practical steps that health care professionals can take towards this vision.
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