The document discusses the limitations of current Electronic Medical Records (EMRs), emphasizing their focus on compliance rather than care, and proposes a future where EMRs are more intuitive and patient-centered. It suggests separating data from applications to enhance usability and reduce clinician workload, envisioning EMRs that function as cognitive support systems for physicians. The presentation promotes innovation in healthcare technology to improve patient experiences and streamline workflows.

1. Improving EMRs Problems with Current EMRs Thoughts on Future EMRs April, 2009 Lyle Berkowitz, MD, FHIMSS Program Director, Szollosi Healthcare Innovation Program ( www.TheSHIPHome.org ) Email: [email_address] Web: www.DrLyle.com

3. Usability Problems The NRC Report (Jan, 2009) Summary: Built to resemble paper charts Overly focused on Compliance, not Care Too much clinician data entry and searching Problems with Data sharing and integration Transaction systems with decision support bolted on - rather than as thinking systems with transactions built in Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions . Authors: Willam W. Stead and Herbert S. Lin, editors; Committee on Engaging the Computer Science Research Community in Health Care Informatics; National Research Council. http:// books.nap.edu/catalog.php?record_id =12572

4. Current vs. Future EMRs Future EMR Metaphor: iPhone, Web Graphical representation Information Visualization Interactive/Actionable View Workflow oriented Context is Critical One Click Documentation as byproduct User control Data separated from App Open API Current EMR Metaphor: Paper Word/Excel Information Overload Static View Task oriented Data and Fx Silos Too Many Clicks Documentation as end product Vendor control Tightly bound 3-Tier Closed system

5. What will the Future look like?

6. Short-Term: 0-5 years Compare: Traditional vs. Future Breaking up the 3-Tier Monopoly Examples Information Visualization Context Sensitive Screens Widgets

7. The Current 3-Tier Monopoly of EMR Vendors “ Get those vendors to separate their data from their application .” – Dr. William Stead (Jan, 2009) Data Storage Application Processing User Interface

8. Separating The Data from the Applications The Data “Platform” Physician Workflow Tools Data Storage Application Processing User Interface Application Processing Application Processing Application Processing Application Processing Application Processing Application Processing Application Processing Application Processing User Interface User Interface User Interface User Interface User Interface User Interface User Interface

9. Another way to look at it Multiple Care Settings Single Care Setting EHR EMR PWT EMR PWT PWT PWT

10. Potential Future for EMR Vendors Good Higher adoption More widgets to sell Bad They become commoditized to Data storage experts Users start consolidating

11. New Ways to Look at Information

12. Problem List: Current View

13. Problem List – Future View #1

14. Problem List – Future View #2

15. Problem List – Future View #3

16. A New Way to Look at Results

17. A New Way to Look at Results

18. Context-Sensitive Screens and Widgets

19. Problem Details

20. Problem Details

21. Med Refill Widget

22. Patient Name: Joe Kind DOB: 01-01-60 Medical Record #: 123456789 Allergies: Penicillin (Rash) Active Med List Norvasc 10mg Lisinopril 20mg Zocor 20mg Appointment Data Date of last visit: 1/17/09 Date of next visit: none Notes Actions Contact patient to review Repeat K in one week Increase cholesterol medication RTC in 6 weeks IM Cardiology More CHEM PANEL Creatinine: 2.2 Potassium 5.4 LFTs - WNL Cholesterol Profile LDL 124 (Goal < 100) HDL 44 (Goal > 45) TG 122 (Goal < 150) CBC Hb 14.1 (Normal range: 13-15; Pt Range 13.9-14.8) within normal range 0.3 (2%) below average of last 2 years Other: WNL Cr K LDL HDL

23. Future: 5-15 years Transform the Computer From a machine that simply responds to your actions To the best assistant you ever had

24. “ Patient-centered cognitive support” The authors said the “overarching, grand research challenge” of the computer science research community is developing “ patient-centered cognitive support .” Computer systems need to build virtual models of a patient’s status, models that depict and simulate a theory about interactions going on in the patient similar to those models going on in the head of a physician working unaided by a computer. - NRC Report (Jan, 2009)

25. A robot that understands…

26. Current EMR Workflow Patient and EMR wait for Physician Physician does all data review and input

27. Future EMR Workflow EMR gathers data, creates documentation and suggests a plan Physician reviews and edits EMR summary and plan

28. Potential Time Savings Physician then has more time to spend with patient for tough diagnostic analyses, education, etc…

29. This presentation was sponsored by… www.TheSHIPHome.org

30. SHIP Description Mission Use creative thinking and diverse technologies to produce a better healthcare experience for patients, physicians and others associated with their care. Vision Develop, test, and use innovative solutions within the real world of Northwestern Memorial Physicians Group, and then spread these ideas and solutions outside our organization.

31. Thoughts on Innovation Innovation is a systemic process that draws insights and ideas from inter-disciplinary groups… in a conscious, purposeful search for innovation opportunities . - Peter Drucker The oldest habit in the world for resisting change is to complain that unless the remedy to the disease should be universally applied, it should not be applied at all. But you must start somewhere. -Winston Churchill Don’t tell me what you can’t do. - Peter Szollosi