Intelligent Healthcare: EHR Assumptions

The term, Electronic Health Record (EHR), is often used synonymously with Electronic Medical Record (EMR) or Longitudinal Health Record to describe systems that capture medical chart data in electronic format. The nature of the data being captured and how it is used varies from system category to system category as well as across individual vendor implementations in every category. There is no standard solution configuration in terms of features, functions and performance. There is some standardization in relation to the data elements employed though as many vendors have attempted compliance with one or more Healthcare Interoperability standards. The design and implementation of EHRs does not necessarily take into consideration the larger ecosystem in which it will inhabit and in fact there are many different types of environments that they may be built to support including:

•    Smaller medical practices
•    Mid-sized Healthcare providers (clinics, specialty care)
•    Larger Healthcare providers (Hospitals)
•    Health Networks
•    Agency / National level (NHS SCR, DoD AHTLA, States etc.)

By now EHRs should be universal and fully interoperable - they're not...

The development and use of EHRs has in many instances been controversial and there has been significant resistance to it by practitioners and limited evidence of improved outcomes from organizations which have adopted them. One particular area of controversy revolves around whether the family of EHR solutions has either accurately understood and supported existing Healthcare processes or made any headway in actually improving those processes. Despite this situation, EHR technology has remained the primary focus for Healthcare solutions modernization or transformation. To understand why EHRs have not lived up to their potential, it is worthwhile to explore some of the (perhaps false) assumptions behind them:

•    Assumption 1 – That because much or most of current Healthcare process is ‘paper-based’ that it is necessarily inefficient. Paper-based process can in fact be highly optimized, or sub-optimized thus facilitating processes in situ. The enterprise perspective must also support the needs of component Healthcare delivery.

•    Assumption 2 – That full standardization of a domain of practice as complex and evolutionary in nature as Healthcare is even possible. And that the domain would become subordinated to the woefully incomplete (lagging) standardized view and thus tolerate degradation of care to support the larger goal of automation.

•    Assumption 3 – That technology might be imposed without engaging in full partnership with both care providers and patients. This is particularly critical in determining performance expectations in relation to care practice. In other words, if it takes a doctor 15 minutes to manage a typical patient encounter using a paper-based approach and 30 using an EHR then the EHR has failed to meet minimum expectations and communication between the IT provider and care provider failed.

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