EHR 2.0: the next generation of healthcare

The next generation of Electronic Health Records (EHRs) is starting to take serious shape. It’s not quite center-stage yet, but we can see it from here. What elements of “EHR 2.0” distinguish it from the legacy of EHRs that currently dominate the marketplace? A number of defining features can be described, and can serve as guidelines for physicians who want to digitize their clinical practices (and take advantage of the CMS bonuses for “meaningful use” in 2011), but are unsure of what to consider.

The Office of the National Coordinator (ONC) for Health IT has defined a set of features that an EHR needs to have in order to be Certified. Unlike prior EHR-industry derived legacy certification (the old CCHIT certification), the new federally-defined Certification focuses more on interconnectivity, patient involvement, reporting of clinical quality, and data-based prompting at the point of care.

Is this a sufficient guide for physicians? Yes and no. Many of the large, cumbersome EHR products that have been part of the problem (and resulted in the very-low adoption rates of such products, especially in small physician practices) have fit themselves to the current federal Certification criteria without changing very much. Sort of like a dinosaur putting on a mammal suit in order to keep up with evolution.

What, then, should a physician consider when surveying the dizzying landscape of all the choices out there? Given that every Certified system will have a similar set of functional features, we would suggest the following categories in the check-list: (1) connectivity, (2) usability, (3) mobility, and (4) data-driven capacity. These are the elements that will define the “EHR 2.0” systems of the future.

Connectivity
The whole thrust of modern health IT is around connectivity – getting information about a patient from where it is housed (often, fragmented into many places) to where it is needed at the time of care; and involving the patient directly as an active participant in his/her health. A recent article on EMR 2.0 describes the efforts made by Practice Fusion and others in the realm of bringing the walled silos of traditional health IT together into something more cohesive. Much of the efforts of the ONC revolve around connecting health data together, as we previously reviewed.

Usability
If an EHR slows a clinician down, it will not be used. Or at least (if the clinician is in a setting where she is essentially forced to use something installed in the enterprise in which she works), the EHR will be resisted. The common perception is that EHR adoption will result in a period of time (the “learning curve”) where productivity is reduced – this may be a significant dip in revenue (like more than 10%) and may last for weeks-to-months. Some practices may not recover their prior level of productivity for as long as a year!

The key, from the perspective of emerging EHR 2.0 technologies, is creating a set of tools that are fast, nimble, easy to learn, and built the way physicians need them to work. Self-service implementation (possible with web-based solutions) has clearly aided in time-to-adoption, eliminating the need for vendor consultants to come on-site and install software and conduct training. EHR 2.0 companies will be ones that pay very close attention to the user experience, and help get physicians from being “dabbling hobbyists” to full-fledged “meaningful users.”

Mobility
Health IT will be increasingly more mobile. The days of needing to be in-house to use workstations connected to a local network are going away, and being replaced by access to health IT wherever you are. Mobile Health is an emerging term. The expectation is that mobile devices (smartphones, home-based devices, medical equipment) will seamlessly connect with a patient Personal Health Record (PHR) and also their physician’s EHR. An entire industry is emerging in this realm, and the kinds of products that will result from this might not even be imagined at this time.

Data-driven
We are entering an era where data is king. This is true now for many consumer-oriented products (consider using Google Maps on your smartphone), and is becoming true for health IT. One can think of data-driven health IT in two ways:

  1. Patient-specific data. Physicians and patients will have access to all the data, from all the sources, at-hand when making decisions. Clinical disease support – what is the right diagnostic or therapeutic next-step, given what is known about a situation – will become mature. Ad-hoc reports of patients who need follow up (“give me a list patients who have had a heart attack and are not on beta blockers”), with individualized follow up contact methods (email vs. phone vs. PHR) will become the norm.

  2. De-identified data. Research and health policy is based on data, and access to very large data stores is becoming possible. An example of this is Practice Fusion’s teaming up with Microsoft’s Windows Azure Marketplace to support health research. Correlations not previously suspected, as well as data to support what had been speculation, come from these. For example, is Body Mass Index (BMI) correlated with socioeconomic status? With number of fast-food restaurants in a zip code? Who is at risk for obesity? What things (that can be changed) predict the onset of diabetes? These kinds of questions can emerge rapidly from the vast data stores that are emerging, but have been historically disconnected.

Healthcare is entering a time where the future will look very different from the traditional past. No longer will the doctor’s office be a swamp of paper, with limited and incomplete information at hand when clinical recommendations are made, and with costly waste ingrained in the system. The future will have doctors with mobile, connected devices that tap into secure yet complete data repositories, where all the needed information about a given patient is at-hand, and robust data-supported clinical decision support is rendered to everyone everywhere. It’s not yet a reality, but this realm of EHR 2.0 can be seen from here.

Robert Rowley, MD
Chief Medical Officer
Practice Fusion EMR