In thinking about the role of EMRs in coordinating care, I am reminded of the old story about Apple’s and Microsoft’s original mission statements. According to lore, Apple’s first mission statement was “a computer in every home,” while Microsoft’s was “a computer in every office.”
As it’s played out in the decades since, one company came to dominate the education field, disrupted the music industry, developed a multi-function phone and eventually tablets, smart watches and personal health devices. The other built scalable operating systems, spreadsheet and word-processing functions, presentation capabilities and calendar applications. To me, the different evolutionary paths exemplify how fundamentally different products and innovations can grow from different intentions and visions. The name of their main application suites – Office for Microsoft, and iLife for Apple – more or less says it all.
The histories of Microsoft and Apple also demonstrate how market shifts affect companies. IT pros used to openly question if Apple was even a technology company or merely a maker of consumer goods and personal entertainment devices. Today, Apple’s products are now widely used in large corporate enterprises (often in BYOD programs) for the simple reason that users prefer them. On the other hand, Microsoft is scrambling to develop consumer-friendly devices that will capture people’s hearts and imaginations.
With many in healthcare asking if EMRs are able to handle care coordination (the increasingly important task of navigating and supporting patients as they move through complex treatment plans involving multiple specialists and functions), it’s worth asking about the original mission or purpose of EMRs. These large systems were designed to be an MD-centric technology that served as a single point of information for clinical activities and decision support within acute care facilities. The current interfaces, functions and workflows in EMR systems still represent that intention, with underlying technology that was first developed in the 1980s. So, for organizations that treat all of their patients in a single, centralized facility and are exclusively focused on clinical work, EMRs may be the only technology they need.
With healthcare now typically involving more complex treatment journeys for patients, involving multiple specialists and facilities, conformance with the clinical decisions made with EMRs is decreasing. Care coordination fills the gap by handling non-clinical tasks (like patient communications and sharing information across multiple facilities) so patients can follow the recommendations their doctors make. In this world, the centralized nature of EMRs no longer suits how care is actually delivered. Simply put: not everyone treating the same patient has access to the same EMR, meaning the system can no longer serve as the single source for all relevant patient information and decision support at every point on the patient journey.
That’s one reason, in some cases, physicians don’t like them, having:
“noted important negative effects of current EHRs on their professional lives and, in some troubling ways, on patient care. They described poor EHR usability that did not match clinical workflows, time-consuming data entry, interference with face-to-face patient care ...”
The “technology has let us down,” according to other observers.
The bottom line is that the size and complexity of EMR platforms make it very difficult to update them to the distributed computing models that are the norm today. It is hard to believe that these platforms and their dated technology structures will suddenly change to support patient journeys across a system of care of which the EMR is only one part.
EMRs are not going away anytime soon – if only because many hospitals have made huge investments in them. That’s why it’s worth asking if and how they can be adjusted and repositioned to reflect the new world of healthcare – with its increasingly empowered patients, fragmented treatment paths and urgent need for data sharing and systems interoperability. What other tools and technology can complement EMRs in coordinating care and navigating patients across these complex care paths? Can EMRs undergo an Apple-like evolution or will they remain like the “PC” character in the famous old TV spots? In short, can EHRs evolve to do care coordination? I’ll explore that critical question in a future post.