An excellent piece on the state of electronic medical records from primarily an administrator standpoint. Well worth the long read; always good to know the enemy’s perspective. A few thoughts:

To date, the priorities of most health care organizations have been replacing paper records with electronic ones and improving billing to maximize reimbursements. Although revenues have risen as a result, the impact of IT on reducing the costs and improving the quality of clinical care has been modest, limited to facilitating activities such as order entry to help patients get tests and medications quickly and accurately.

The quote represents the crux of the problem–EMRs to date have been implemented to maximize billing (read: make sure no money is left on the table). Hospital administrators have assessed the EMR options and purchased the best products to achieve this goal. Doctors, nurses, and other care personnel have rarely been involved in the decisions, therefore, the products selected are not optimized for patient care (read: no increased productivity, only more headaches). Until doctors/nurses have direct input into purchasing decisions, I think there is little hope for this to change. [1]

Relatively few organizations have taken the important next step of analyzing the wealth of data in their IT systems to understand the effectiveness of the care they deliver. Put differently, many health care organizations use IT as a tool to monitor current processes and protocols; what only a small number have done is leverage those same IT systems to see if those processes and protocols can be improved—and if so, to act accordingly.

I would say that most hospitals aren’t even effectively using their EMR data to “monitor current processes and protocols”. Clinical informatics–the nascent field of applied IT in healthcare–and quality improvement are only beginning to come together in large academic medical centers to nail down effective evaluation of their ongoing data streams. It is going to take time and development of talent/expertise in these areas before the true potential of EMR data for improving outcomes is harnessed. It will take even more time for efforts to then translate to smaller hospitals and private practices.

So how can health care organizations realize the promise of their large and growing investments in IT to help lower costs and improve patient outcomes?

I know this is the Harvard Business Review, but please–improving patient outcomes should always come before lowering costs (generally improving outcomes lowers costs).

Two key constituencies outside of technical personnel—senior leaders and clinicians—must play significant roles. Leaders are crucial because they will have to enlist clinicians in the cause by persuading them that the effective use of IT is central to delivering higher quality…

If IT is implemented in a way that makes clinical workflows efficient, then no convincing will be necessary. Make it easier for doctors and nurses to do their jobs, feed data back to them to help them be better at their jobs, and minimize technical glitches. Quite simple.

The pledge to improve quality should be more than words; it must be translated into visible practices.

Duh. Again, I know this is a business journal, but does that really need to be said? This article could have been much shorter.

Besides acquiring the necessary hardware and software, leaders must make complementary changes in their operating and business models to generate and capture value. Of primary importance is investment in dedicated information-technology and analytics staff—individuals tasked with managing the IT system or analyzing the data it contains.

This isn’t said until the last part of the article, but at least it was said. The IT infrastructure in a large academic medical center is huge; their staff needs to be huge too.

All in all, a relatively good article, but could have really benefitted from a physician perspective amongst the four authors.

It’s a pipe-dream, but I long for the days when each doctor will be able to pick their own interface with the EMR. That is, instead of my hospital purchasing Epic or Cerner for everyone to use, they will have a “dumb” EMR backend that anybody can choose whatever product they want to use to access that “dumb” EMR. Twitter clients are an example of this in action. With a Twitter account, I can choose to access it via the Twitter website, Tweetbot, Twitterrific, Echofon, or any other client. It’s all the same Twitter service, but each presents the information and interaction in its own unique way with consequent pros and cons for each. ↩