EHR 3.0

In an article published last month in the Journal of the American Medical Informatics Association, the EHR-2020 Task Force, made up of 14 veterans of medical informatics, issued 10 recommendations in 4 key areas, with the goal of a person-centric, learning health system in the next 5 years.

The EHR-2020 Task Force recommendations include:

1. Lessen the data entry burden for clinicians.

2. Separate data entry from data reporting, and let non-physicians, including patients and their families, enter some of the data.

3. EHRs should support systematic learning and research at the point of care during routine practice for both billing and care-delivery purposes.

4. Regulators should clarify and simplify EHR certification procedures, emphasize health information exchange and interoperability, cut the need for duplicate data entry, and make patient outcomes the goal of certification rather than EHR functionality.

5. Reimbursement rules should “support novel changes and innovation in EHR systems.”

6. There should be more transparency into the EHR certification process in order to improve usability and patient safety.

7. Healthcare providers and vendors alike “should be fully transparent about unintended consequences and new safety risks introduced by health information technology systems, including EHRs, as well as best practices for mitigating these risks.”

8. Vendors should use application programming interfaces and follow public, open data standards.

9. EHRs should be integrated into the “full social context of care, moving beyond acute care and clinic settings to include all areas of care: home health, specialist care, laboratory, pharmacy, population health, long-term care, and physical and behavioral therapies.”

10. User Interfaces should be designed around how people think because, as the article says, “Usability is a real science and goes beyond screen design.”

As noted by the task force report, innovation will be key to get us over the goal line. There are many gaps in EMR and Healthcare IT (HIT) design, development, and deployment including poor communications between developers and clinicians, a rudimentary digital health clinical trials ecosystem to clinically validate eHealth products and services, firewalls that prevent testing and piloting of eHealth solutions in clinical settings, and a general lack of digital health education and training in medical schools and graduate education programs.

Using information and communications technologies (ICTs) to improve health and quality and reduce costs will take some time. Sick-care and higher education are 2 large industries that have lagged in adopting ICTs to deliver their products, improve the user experience, and cut costs, and the 2 industries’ cultures are highly resistant to change.

We are only beginning to see early models of what most believe are technologies that will change how doctors take care of patients and how patients take care of themselves.

Like the automobile that created radical societal change, it took some time and the Model T was only one of the early first steps. Hopefully, with the collaboration of members of an expanding digital health ecosystem, including more open innovation between academics, industry, and community providers, we'll be seeing innovative products and services that go faster, get us to where we want to go in comfort, are easy to use (maybe even driving themselves), and have a low cost of use and ownership. I only hope we can get it in a color other than black.