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Panel on the future of Electronic Health Records

A presentation I made at the ITCH conference in Victoria in 2017 as a member of a panel of experts on EMRs and EHRs.

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Panel on the future of Electronic Health Records

  1. 1. Karim  Keshavjee,  MSc,  MD,  MBA,  CCFP,  CPHIMS-­‐CA   ITCH  2017    Feb  19,  2017   Victoria,  BC  
  2. 2. ¡  EHRs  have  pretty  much  failed  all   over  the  world     (I’m  talking  about  centralized   medical  records,  not  American   physician  medical  records)   ¡  Why?   ¡  There  are  a  thousand  reasons,  but   the  #1  reason   Our  collective  hypotheses  about   EHRs  are  incorrect  
  3. 3. Doctors  need  data  to  look  after  patients  (duh!)   If  we  give  data  to  them  faster,  patients  will  get  better  faster     (The  “Replace  Postal  Service”  Hypothesis  of  Better  Care)     Let’s  also  make  it  Machine  Readable  so  Computers  can  double-­‐guess  the  doctors!  
  4. 4. ¡  It  may  be  true  (unproven)   ¡  But  solving  this  problem  has   NOT  created  enough  value  to   justify  the  costs   ¡  The  experiences  of  the   Health  Information   Exchanges  (HIEs)  in  the  US   bears  this  out   §  HIEs  are  purer  versions  of  the   “Replace  Postal  Service”  with  a   lower  cost  structure  than  EHRs   §  They  have  also  failed   ¡  HL7  and  Interoperability  are   also  massive  failures  –they   are  also  based  on  the  RPS   hypothesis  
  5. 5. ¡  We  should  be  identifying  and  testing  multiple   hypotheses  as  we  move  forward   ¡  But  how  will  we  know  which  one  is  the  right  one?   ¡  Easy!   ¡  Humans  and  systems  are  good  at  identifying  value   and  embrace  it  quickly   §  Christoph  Lehmann  pointed  this  out  nicely  in  his  Keynote:   When  IT  goes  ‘Viral’,  you  know  you’re  onto  something   ¡  What  we  need  to  do  is  try  out  a  bunch  of  alternative   ideas  and  see  what  works   §  But….where  should  we  look  for  better  ideas?  
  6. 6. Research   Study   Research  Study   Synthesis   Researchers          Academics                                    Clinician-­‐Scientists                  Clinicians                            Patients     Guidelines   The  Healthcare  Value  Chain  
  7. 7. ¡  The  steps  along  the  way  by  which  we  add   value  to  raw  materials   ¡  In  the  Automotive  Industry,  they  take  iron   from  holes  in  the  ground  and  make  nice  shiny   cars  which  you  can  buy  from  your  local   neighborhood  dealer   §  They  don’t  make  you  go  to  Northern  Ontario  to   dig  up  the  iron  and  smelt  it  yourself   ¡  In  healthcare,  we  discover  new  facts  and   treatments  that  we  can  deliver  to  patients  
  8. 8. ¡  There  are  many  stakeholders  in  the   healthcare  system  who  ADD  value  to  the   system   ¡  When  they’re  left  out  of  the  IT  equation,  real   value  cannot  be  created  
  9. 9. Stakeholders   Researchers   &  Academics   Providers   Patients   Ministries  of   Health   Systems   Implementers   Guideline   Implementers   Vendors  
  10. 10. ¡  Lowering  the  costs  of  providing  healthcare  through:   ¡  Predictive  analytics  –to  provide  care  that  matters  to   patients  and  to  allocate  resources  better   §  Everyone  agrees  there’s  lots  of  waste  in  the  system,  but   nobody  knows  where  it  is!   §  Will  need  researchers  and  data  scientists  to  identify  waste   §  More  than  anything,  we  need  better  measurements  of   “What  is”   §  That’s  what  impressed  me  most  about  Christoph   Lehmann’s  presentation  –not  his  great  inventions,  but  the   fact  that  he  had  such  great  granular  data   ¡  Shared  data  for  coordinated  care   §  Virtualization  of  care  beyond  bricks  and  mortar  
  11. 11. ¡  Increased  patient  empowerment,  access  and   control  (mobile  apps,  block  chain)   ¡  Chronic  disease  logistics  (lots  of  patients   falling  through  the  cracks)   ¡  Ability  to  rapidly  test  hypotheses   §  Big  data  is  meaningless  without  hypothesis   testing   ¡  Ability  to  share  innovations  using  non-­‐ commercial  dissemination  mechanisms