stethoscope and keyboard imageI am sitting in Kansas City MO at the Partnership with Patients Summit right now, attending a series of sessions jam-packed with interesting content and ideas from all parts of the healthcare system: patients, doctors, researchers, journalists, advocates, caregivers, the whole enchilada. And it’s a very tasty enchilada, let me tell you.

One of the sessions involved a trip to Cerner‘s world HQ (the Summit is being hosted by Cerner at one of their education facilities in KC MO, which used to be a casino – oh, the irony!) to see their hospital EHR demoed by a member of their clinical sales team.

As a demo, it was most impressive. We followed an avatar patient, a 70 year old man named Walter who has some chronic health issues – Type II diabetes and heart disease in particular – that caused an acute episode. This became the framework of our trip through the EHR user interface, from Walter’s home to a clinic to the hospital and back home again, as Walter’s acute episode was treated.

The process was seamless, with all parts of the care team able to interact with each other at transitions of care. Medication reconciliation (med-rec), which is a HUGE issue for hospitals, was handled by a very R2D2-like pill-o-matic machine that had safety checks built in at every step in the medication-dispensing process. There was additional meds-safety built into the process via a regular interface prompt to review and revise at each hand-off/care transition.

Walter safely moved from home, to the clinic, to the hospital, and back home again, with a seamless transition at each step, which seamlessness was enabled by the Cerner EHR technology. It was a very compelling picture of how the delivery of medical care can be made safer and more user-friendly with technology enhancement.

It’s a beautiful picture. Has that picture been Photoshopped?

I think that it has, but I don’t think that Cerner is the one doing the Photoshopping – at least not all of it. I know from interviewing hospital MDs for the podcasts I produced for the Society for Hospital Medicine that there’s a lot of frustration out there inside hospitals with the actual use of EHR systems in the real world of healthcare delivery. It’s one thing to paint a seamless picture of care transitions when you’re within a closed system – an all-Cerner-all-the-time world – than it is in the very real world that has risen up as health IT has been deployed across the land in the Gold Rush brought on by HITECH, ARRA, and PPACA (Google them!).

EHR technology is still a promise deferred, in large part because of legacy-IT thinking. As healthcare systems look to add EHR to their technology infrastructure, they’re not starting from zero. They’re spackling on a new layer of tech on top of existing systems, some of which were installed decades ago and “updated” regularly since then.

Think of trying to add an Xbox game to an old Commodore 64 game console. You’ll get the picture.

I’m not saying that hospitals and health systems have to throw all their pre-full-promise-EHR tech out the window. I’m saying that legacy thinking in IT needs to get beaten senseless and then thrown out the window. That’s the true barrier to “meaningful use” of health IT.

As my good friend Alicia Staley said to me recently, healthcare systems need a Chief Patient Officer to work with their CIOs, CMIOs, and other C-peeps. Patients have as much skin in the game – maybe even more? – than do providers and payers. This Health IT Gold Rush is taxpayer funded. It’s our money flowing from the feds to those who demonstrate “meaningful use”, and it’s our money – whether it’s direct-pay or insurance-pay – paying for care within those facilities.

Cerner has made a promise. They seem quite committed to delivering on it. All that’s in the way is legacy IT thinking, which includes thinking that the only way a system will be truly seamless is if it’s an all-one-brand system.

There is still much work to be done …

EHR technology: promise delivered? Maybe.
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3 thoughts on “EHR technology: promise delivered? Maybe.

  • January 23, 2013 at 6:39 pm

    And even the translation systems like HL7 that promise to bridge the gap between disparate systems continue to struggle.

  • January 23, 2013 at 6:43 pm

    Very true. Interop is still a promise unkept, and as long as the data’s in silos, we’ll still have to chase our own records from pillar to post in order to make sure everyone’s fully up to speed. Huge challenge in emergency rooms, because … who’s got the full records? No one. Unless you’ve installed a PHR yourself, on your mobile device(s), and have “I

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