From blockchain to interoperability to precision health, medical records are finally undergoing a make-over. |From blockchain to interoperability to precision health, medical records are finally undergoing a make-over.
In 2016, funding to electronic medical record (EMR) companies dropped by over a third, while deal flow remained steady. Nonetheless, the sector is slowly undergoing a transformation set to revolutionize not only the look and feel of medical records, but their purpose.
EMRs are already capable of warning health care workers of potential drug interactions and allergies. The push towards precision medicine, however, has resulted in startups building EMRs aimed at going even further — providing individualized care recommendations based on data gathered from similar patients, medical histories, wearables, and genomics. Key players and investors in the industry believe innovation will be built on common foundations such as data security, personalized care, and interoperability.
Below are 10 perspectives on EMR trends from a variety of corporate executives, government leaders, and clinicians. If we have missed any perspectives that you think are worth highlighting, please let us know in the comments.
1. Shahram Ebadollahi, PhD, Vice President for Innovations and Chief Science Officer, IBM Watson Health
The Food and Drug Administration recently signed a research initiative with IBM Watson Health to determine how blockchain technology could be used in a clinical setting. Specifically, they want to determine whether it could be used to create a secure method of exchanging data. In the current system, patients are often tasked with either scanning, e-mailing, or carrying their medical histories to every new physician they meet. Dr. Ebadollahi is confident the advent of blockchain will enable these disparate data sources to be securely connected and shared among providers.
“The healthcare industry is undergoing significant changes due to the vast amounts of disparate data being generated. Blockchain technology provides a highly secure, decentralized framework for data sharing that will accelerate innovation throughout the industry.”
Kaiser Permanente, a longtime developer of EMRs, is beginning to change its design philosophy. As medicine moves towards a precision care model where each treatment is tailored to a specific patient, we are also beginning to see a demand for more data. Dr. Lieu notes there is a desire among patients for data and specifics around treatment decisions, consequences of those treatment decisions, and quality of life outcomes, information which it is currently difficult to assess.
“The part of it that they didn’t envision that we’re envisioning now, is how proactive a role patients would be taking. Patients are always saying, don’t just give me the averages, tell me what happened to others who look like me and made the same treatment decisions I did. And tell me not only did they live or die, but tell me what their quality of life was about.”
In the current healthcare system, if a patient moves to another state, or even city, to see a new doctor, there is no reason to expect their medical records to follow. Hospital systems, clinics, and private practices all use their own electronic medical record systems. Even when the EMR of one hospital is developed by the same brand as another, data is not shared outside of each individual closed network. Dr. Halamka believes data sharing will not only make life easier for the patient but can have potentially life saving effects.
“Now is probably the right time in our history to take a fresh approach to data sharing in healthcare. The EHRs may be very different and come from lots of different places, but the [blockchain] ledger itself is standardized.”
Dr. Schilsky is another proponent of data sharing between EMRs, also known as interoperability. Indeed, the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology has designed a roadmap for all EHR systems to be able to fully share information by 2024. Achieving large-scale interoperability has the potential to improve coordination of care and reduce medical errors worldwide.
“When EHRs can share information – called interoperability – doctors can more effectively diagnose patients and reduce medical errors, doctors and patients communicate more easily and effectively, and care becomes more coordinated and efficient … Technology has presented us with an unprecedented opportunity to improve patient care. If we squander it because our EHR systems can’t communicate with each other, everyone loses.”
5. Steven Posnack, Director, Office of Standards and Technology, US Department of Health and Human Services
Mr. Posnack supports the development of new electronic medical record technologies but believes enabling data sharing is of greater consequence. From referrals to prescriptions to medical images, healthcare will need to become less siloed and more connected to truly enable an EMR revolution.
“Simply putting the technology in people’s hands isn’t enough. There need to be business agreements in place and, in many cases, a business model around exchanging information that impacts the delivery of care.”
The following is taken from the Jan 18, 2017 hearing on Dr. Price’s nomination to Secretary of the U.S. Department of Health and Human Services. Senator Bill Cassidy (R-LA) initially stated his hesitance concerning government support of EHR implementations, citing potential negative impact on healthcare. Dr. Price believes EHRs are valuable because they enable patients to carry their health histories with them at all times. While this concept is not currently widely implemented, startups are beginning to build personal health records and data storage devices to enable such a transformation.
“Electronic health records are so important because from an innovative standpoint they allow patients to have their health history with them at all times and allow whatever physicians or other provider access to that. We in the government have a role in that but that role should be interoperability to make certain different systems can talk to each other.”
In 2014, The Permanente Medical Group, a division of Kaiser Permanente, began an experiment intended to promote cross-team communication and patient follow-up using the EHR. They used digital markers, inserted by radiologists with a single click, to indicate abnormalities noted on the radiology report. Previously, it was up to the individual physician to search for the radiology report and pick up errors noted in the write-up. This simple command resulted in earlier diagnoses and shorter times from diagnosis to surgery. Consequently, Dr. Pearl is optimistic regarding the potential of the electronic health record to “eliminate distance” between physicians and patients alike.
“The EHR can serve mainly as a source of information and documentation, and for many doctors, it’s frequently nothing more than a tool for claims and billing. But it can also add major clinical value and be a powerful force for abbreviating time, eliminating distance and dramatically improving patient care and convenience.”
The Cancer Moonshot is an initiative started by President Barack Obama and Vice President Joe Biden along with the National Cancer Institute. It is intended to accelerate research towards developing more therapies as well as prevention and detection methods. Mr. Simon believes one of the most important goals of EMR development should be to enable patients to have true ownership over their medical record. He hopes patients will eventually be able to not only access their record online but share it between doctors, enabling a seamless transfer of care.
“There are a lot of things that had been going on, but the big question is how soon will it be as simple as downloading anything else on the web for people to download their medical records in a way they can use them, share them, manipulate them in terms of highlighting things and moving things around so they can share them with doctors for second opinions, they can share them with researchers, they can share them with other providers?”
Allscripts is one of the largest providers of practice management and electronic health record solutions in the industry. From this role, Mr. Black believes analytics layers on top of the EHR will become valuable as disparate data sources, such as genomics, continue to be digitized. This will result in the EHR being able to consider a patient’s medical problem from multiple vantage points and produce a suggested diagnosis.
“We’ll see other nations undertaking large IT projects at scale; there will be a global focus on this, either organization by organization or ministry of health by ministry of health. Secondly, I think all the data that is a byproduct of the mass digitization will be a boon for analytics … And I believe there will be price-performance that leads to mass adoption of genomic testing. And then having diagnostics, based on data, come out of an EMR to clinicians so they can order the test, get the results back in the EMR and know how to personalize care regimens. If I look out 10 years, we’ll be surprised and shocked at how quickly these things become commonplace.”
Dr. Weng, a staff physician at Baylor College of Medicine, believes that while EMRs already offer plenty to the healthcare industry, systems will continue to evolve due to the advent of new technologies such as machine learning and AI. She also notes the amount and quality of data in the system will be important if these technologies are to have a real impact.
“EMR systems already offer numerous benefits and will ultimately help us unlock what could be the next frontier of medicine—big data analysis, machine learning, and artificial intelligence, all of which depend on a vast but high-quality data set. It will certainly be worthwhile to continually improve on these systems and how we use them. After all, an EMR system is only as good as its data.”
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