The Future of EHRs

The future of patient health records is not merely electronic. It’s predictive, agile, mobile, and very personal. Most of all, it’s comprehensive.

The future CHR will follow patients regardless of where they receive care, blurring organizational boundaries and creating one virtual system across the world. Caregivers will have a complete picture of the patient’s history and seamless communication with the entire care team (regardless of EHR) to improve care coordination. External data will file to the chart automatically, closing care gaps and triggering decision support to reduce duplicate tests. Patients will have a combined view of their healthcare record without having to log in and out of different portals.

Patients will be safer, through a blend of standardized and personalized care models. Today, organizations may have standardized pathways for COPD, for example, but advancements in social determinants of health and genomics-based medicine will empower physicians to tailor care towards each patient’s best outcome, within the guardrails of standardized, evidence-based approaches. Additionally, improved algorithms will measure the efficacy of teams and interventions, and suggest optimized outreach programs and campaigns.

The delivery of healthcare will continue to move outside the walls of hospitals and traditional clinics, and increasingly into lower-cost settings of care, including the patient’s home. Telemedicine will become far more common, enabling healthcare organizations to provide more affordable and convenient care, as patient monitoring devices that stream information back to healthcare hubs grow significantly in number and accuracy.

As the data generated by those devices and other external sources accumulate, the use of emerging technologies will become paramount: Natural Language Processing (NLP) will surface actionable information from unstructured sources, while machine learning and predictive models will sift through the data, promote the key facts, and even prevent adverse outcomes in real time. In the hospital, intensivists will manage larger and larger cohorts of bedded patients remotely, as this technology identifies the patients most at risk and in need of their attention.

Clinicians will have the right form factor for the right use case, as they use a combination of desktop computers, mobile devices, and wall-mounted screens best suited for their location and preference. In the exam room, many of today’s keyboard interactions will become voice interactions where physicians retrieve information and place orders with their voice alone. Ambient recording devices (with the patient’s consent) extracting the salient points from the conversation won’t be far behind.

Clinicians will personalize the technology to match their style of practice. When appropriate, machine learning will serve up defaults based on the usage patterns of a given person or their colleagues. Similar technology will identify opportunities for physicians and other advanced care practitioners to hand off tasks not requiring their expertise to other caregivers like care managers, nurses, social workers, and even pharmacists.

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Achieving this vision is possible, but we must work together to overcome the hurdles.

Across the industry, reimbursement structures for telemedicine are inconsistent or non-existent.

Some government regulations, like the CMS documentation guidelines from the 1990s, lag decades behind the technology. This hinders the adoption of cutting edge features designed to reduce the administrative burden on clinicians. Other regulations introduced more recently aim to collect more patient data. While well-meaning in nature, some have exacerbated the acute time squeeze felt by physicians and other advanced care practitioners in the United States.

Here are steps that healthcare organizations can take to make this future a reality:

• Engage patients in collecting genomic and social determinants of health data, as this information will be key to personalizing the most effective treatment plans for each patient.
• Encourage virtual patient engagement across the board. Allow patients to schedule their own appointments, fill out electronic questionnaires ahead of visits, and share their data from home monitoring and wearable devices. Take advantage of opportunities for electronic visits and telehealth.
• Commit to a culture that embraces and promotes change. If the last decade was about EHR adoption, the road to the CHR will be built on agility. Clinicians are accustomed to their phones updating automatically as they sleep, and expect updates to their health system’s technology to keep pace with this commercial technology.
• Streamline governance structures so that new features find their way into clinicians’ hands much faster than they do today. Changes in the reimbursement landscape will require similar agility as the industry (slowly) moves towards value- and risk-based contracts.
• Stay informed and engaged with federal and state agencies. Pool knowledge with peer communities, trade associations, professional societies, and local user groups. Band together and lobby for the changes most needed by your clinicians and patients, and oppose changes that would increase the physician burden.
• Adopt existing universal code sets whenever possible, like LOINC for lab test components. This will help data move seamlessly across systems going forward. Where no standardized terminology or code set is available (e.g. procedures), collaborate with other stakeholders to create new standards, or find other creative ways to reduce friction when sharing this information.

No doubt this will be a difficult undertaking. That doesn’t mean we can’t have some fun along the way.

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