Opportunities, challenges and benefits of the Electronic Health Records (EHR) revolution
As an experienced clinician, surgeon, teacher and industry expert, Dr Robert Wah, Vice President and Chief Medical Officer, CSC’s North American Public Sector, is an influential member of the medical and technology community. Wah,is also responsible for developing strategy and leading and evangelising the CSC Healthcare point of view. He discusses the opportunities and benefits of EHR.
What role do health information systems play in our efforts to improve healthcare?
At CSC, we develop, implement and run electronic medical records systems that benefit doctors and patients by delivering better information for better decisions. Patients make more informed decisions with better information about doctors, their diseases and healthcare plans. Doctors and hospitals make better decisions with more complete patient data and information about the latest therapies. Governments make better policy, and insurance companies make better decisions when they have the latest information. And researchers clearly make faster progress if they have more information and larger data sets to work with.
How are electronic health record (EHR) systems evolving to make this change happen?
I see three distinct phases spanning the last 20 years and continuing into the near future. The first phase was moving from paper records to digital information. Like most industries, we’re making that transition. While that’s happening, we’re entering the second phase, connecting these islands of data we’re creating. The third phase happens when these data have been joined together, where we will do analytical studies that weren’t practical to do before.
As we enter that analytics phase, what are some of the outcomes we can expect?
To begin, we will be able to get much more specific with each person for his or her particular disease. In the past, our remedies were generic. If someone had diabetes, we’d say to everyone, “For diabetes, do the following things.” With more digital, connected information available, and a greater ability to analyse that data, I can now say, “You’re a 32-year-old Hispanic female with the following family history, and these four medications — and for you specifically — this is what we recommend.”
Another example is the impact on research. As a medical student, I did a study on babies born with part of the abdominal wall missing — a rare occurrence. That study is still the largest conducted on this problem because the effort to collect the data was so laborious. In the near future, I would expect to be able to gather a much larger set of patients, covering a recent period, and in a much shorter time frame, allowing doctors to fully capitalize on the benefits of electronic medical records for research purposes.
What innovations excite you most about future of health information systems?
I see health systems combining with cybersecurity, identity management and cloud computing. These are all separate technologies, but they’re coming together quickly, and at the center of that intersection is the patient. We need to employ industrial-strength cybersecurity and identity management because patients are rightly concerned about the privacy of their data. Digital data has more controls and safeguards, such as viewing logs rather than paper records, but when data like a patient’s HIV status is exposed, it’s like a bell that can’t be unrung. This is an area where CSC is highly qualified. We have world-class experts who have developed and deployed security solutions for financial services and government.
Mobile devices and cloud technologies promise to deliver innovative new services and provide important data-collection capabilities. CSC recently purchased a company that modifies inexpensive netbooks, making them simple data-collection devices that are also capable of connecting patients and doctors via video.
How are the requirements of the meaningful use mandate influencing the evolution of EHR systems?
There was an aspiration behind meaningful use to improve care and speed up implementation. Some concerns have been raised that the requirements focus the industry on a specific set of functions dictated by meaningful use requirements, to the exclusion of other aspects of usability and workflow that are also important. We need to make sure those human-machine interface and workflow elements are addressed.
What have we learned from past attempts to implement these types of systems?
It’s important that we not talk about technology alone. How do we use technology to deliver better care to our patients? What is the ideal workflow? We really have to focus on the steps that take place in an office or hospital that will take full advantage of technology that paper can’t make happen. When we think of these efforts as just another technology project we fall into a trap.
Stage 2 rules require a higher degree of patient participation in the EHR system. How will that work?
That’s a challenge. There are wide variations in patient interest and sophistication with technology, so we can’t make broad assumptions about what people will do. One of the frustrations that doctors and hospitals are voicing is the limited influence they have over how actively patients use the system. What they do when they get home is essentially outside our control.