JAMA: EHRs aren't keeping up with evolution of other technologies

Stanford clinicians shine a light on how today's products are missing out on big opportunities.
By Mike Miliard
10:53 AM

Use of electronic health records has come a long way in the past decade. But so has the ubiquity and maturity of many technologies. A new report in the Journal of the American Medical Association, in fact, argued that EHRs need to play catch-up to make the most of other data management advances.

As tech-savvy strategies for diagnosis, monitoring and treatment have become commonplace, EHRs aren't always able to capitalize on the ways they can help improve care, wrote the authors, Donna M. Zulman, MD, Nigam H. Shah and Abraham Verghese, MD, all of the Stanford University School of Medicine.

"The EHR has many virtues: It supports arduous and time-intensive tasks such as order entry and medical history review, and most systems routinely alert clinicians if they prescribe medication combinations that might cause harm," they noted. "But the evolution of EHRs has not kept pace with technology widely used to track, synthesize, and visualize information in many other domains of modern life. 

Precision medicine: Analytics, data science and EHRs in the new age

"While clinicians can calculate a patient’s likelihood of future myocardial infarction, risk of osteoporotic fracture, and odds of developing certain cancers, most systems do not integrate these tools in a way that supports tailored treatment decisions based on an individual’s unique characteristics," they added.

Analytics tools have made great leaps in recent years too, the authors pointed out, with providers able to deploy complex algorithms to spot patients at risk for hospitalization or readmission. But most IT systems still have a hard time marshaling data to deliver personalized medicine.

"Existing EHRs also have yet to seize one of the greatest opportunities of comprehensive record systems – learning from what happened to similar patients and summarizing that experience for the treating physician and the patient,” they wrote.

The report also faults current systems for note bloat, overpopulation with cut-and-paste clinical information, alert fatigue and poor user experience. "Advances in personal computing and the entertainment industry suggest immense possibilities for more thoughtful and valuable ways of depicting information,” the report said.

But the authors argue that the "most important shortcoming of the EHR is the absence of social and behavioral factors fundamental to a patient’s treatment response and health outcomes."

With consumers wired up to wellness trackers and other gadgets like never before, and able to connect with their providers via now-commonplace patient portals, "it should be possible to collect from individuals key information about their environment and unique stressors — at home or in the workplace — in the medical record," they wrote.

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

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