This past year in Health IT has brought us some unprecedented advances. The federal EHR Incentive Program (Meaningful Use) went live, and money began to be paid out. Electronic Health Record (EHR) adoption took a significant upturn, in part spurred by the federal incentive, and in part spurred by the availability of sophisticated low-cost (even free) options that became viable options for healthcare providers. We have seen web-based EHRs become a dominant force in EHR adoption for small-group and solo clinicians, who would otherwise be priced out of the market.
The use of web-based EHRs will continue to expand. Historically, EHRs have been locally-housed, very large and very expensive systems, used primarily in large clinic, hospital or integrated delivery-network settings. In the past 2 years, we have seen web-based EHRs, become an increasingly sought-after alternative. Such systems, besides being dramatically easier to implement – no servers, no local network needed, no local data backup – are also much less costly (even free).
The design of the EHR, when it is web-based, can also be much cleaner and intuitive – not the cluttered display so common among older programs that results in a longer learning curve to achieve proficiency. Our own goal is not necessarily to compare ourselves to other EHRs and try to make the easiest-to-use one; it is to make a great web program that matches or surpasses the best of any other web program (outside of simply health care).
Despite the progress made in expanding EHR adoption among clinicians in this past year, most clinical practices still use paper-based documentation as their backbone. Being far from a saturated market, it is quite reasonable to expect that the same dynamics that led to the rise of web-based EHRs as the preferred way of adopting this technology by the wide array of smaller practices (and even some larger ones) will continue to be seen in 2012.
Significant strides in achieving real connectivity will be seen. Getting health records to flow from where they are kept (with disconnected pieces scattered across a fragmented landscape) to where they are needed has been one of the main drivers of EHR adoption.
There have been several ways of achieving this kind of interconnectivity. The simple point-to-point way of sending information between known parties (faxing, or the Direct Project) will begin to be more widely used, as the networks and the capability to send and receive such messages mature.
The more complex Health Information Exchange (HIE) ideal of building “library-style” repositories of health data that can be uploaded to, and downloaded from, remains in its infancy. A few demonstration sites have emerged, but many are like building a “Tower of Babel” and will suffer from high cost, prolonged implementation and integration processes, and therefore few subscribers.
As web-based EHR networks (particularly free ones, where accounts can be set up quickly, simply, and without cost) become even more widely adopted, in-system chart sharing will be a major story in 2012. Charts (or specific elements within those charts) can be shared between disconnected clinical practices upon patient referral and permission, simply by “extending the platform” – offering the recipient a quick sign-on, such that when the account is created (in a couple of minutes) the shared chart is what populates the new account. The use of this novel method of clinical data sharing may well eclipse the traditional HIE buildup – one does not need to wait for the elaborate Nation-Wide Health Information Network to be built and be functional, in order for health data to be shared between different clinicians.
The use of anonymized “big data” from EHRs will add significantly to medical knowledge. Health data, anonymized and used in ways that fully protect individual privacy (per HIPAA requirements), will become an increasingly important source of information that will fuel our understanding of disease as a society.
The Centers for Disease Control (CDC) are trying to capture EHR diagnosis data quickly, as-it-happens, in its Syndromic Surveillance efforts – part of its bioterrorism early detection program. “Big data” analysis of huge amounts of information inputs are being built now, and will be a big story for 2012.
Similarly, things like post-market drug surveillance (identifying unexpected problems in medications long before the traditional reporting process can do so), or actual comparative effectiveness research (looking at different treatment approaches for the same medical condition and seeing, based on actual data, which one works best), or studies of health disparities among different populations – all these things will come from the use of EHR data (rather than the billing-data sources, fraught with their inaccuracies, which have been used in the past).
Consumer data will flourish, and become linked to personal medical data. Consumer-created health data on the Internet – things like tracking one’s walking, exercise, calorie intake, etc. – will continue to expand. Mobile health apps and web apps (e.g. Facebook apps) will continue to explode in popularity. This kind of self-reported data is outside the walls of HIPAA, and has become popular in relation to its ability to be shared socially. We have seen that private, Personal Health Record (PHR) data, when disconnected from their physicians’ EHRs, has not taken hold – but socially shared self-reported health information has been wildly popular.
Such data is a vast sea outside the walls of traditional health care. In 2012, we will see ways in which this data (summarized via inventive, compelling data visualization tools) will become shared with a patient’s physician. The consumer-based health data, upon direction by the consumer (patient), will find ways to be “posted” to one’s EHR-connected PHR. From there, it can be shared with the physician – once it becomes accepted into the clinical EHR, such data then becomes Protected Health Information (PHI), and cannot be shared with others without the permission of the patient.
Increasingly, the patient will be in control of their health data, whether generated and shared by their physician (EHR-to-PHR), or whether it is consumer-generated (or device-generated) and shared from patient-to-physician. The empowered patient will increasingly become the norm, and will shape health care in years to come. 2012 will see significant strides in this arena.
These areas of Health IT will all see significant change in 2012. We need to both build along these lines, and allow ourselves to be surprised by innovation that will make these kinds of changes occur in novel and unexpected ways. May it be a good year for all involved!