In today’s hyper-connected world, it’s hard to remember that at one point, all our health data existed on paper. When you arrived at a doctor’s appointment, a nurse or administrative assistant would go to a huge shelf filled with manilla folders complete with paper records and pull out your files. For some of us, this could have been the case until the 1990s and 2000s.
Nostalgia aside, the time before digitization was chaotic for both doctors and patients. Records could be lost or misplaced, and it took a lot of time and money to deal with patient data. The electronic health record (EHR) changed everything, and the history of the EHR actually goes back much further than you might think.
Today, we’re living in a digital world, and it has important implications for not only healthcare administration but also healthcare delivery. Those implications go beyond the ability to look up a record with the push of a button: they bring new opportunities but also critical new challenges for patient privacy. Let’s talk about how the digitization of the healthcare industry is disrupting the handling of patient data and the amount of data to be accessed over time by specialists.
How the EHR Changed Healthcare Industry
The EHR is a buzzword today, but its origins date back to 1968 when Dr. Lawrence Weed developed what he called the problem-oriented medical record (POMR). It was the first successful attempt to simplify patient record keeping and open up further possibilities for patient data. The POMR included a database, problem list, note section, planning feature, and discharge summary section that brought together the most information possible to create a full picture of each patient’s care needs.
By the time the EHR arrived in 1972, it was long clear that collating patient data correctly could transform healthcare. The Veterans Administration (VA) was the first major organization to use the EHR, but even still, there were issues with both adoption and standardization. Because even if a healthcare organization created a huge amount of data, it was not necessarily doing so in a way that was transferrable to other organizations. And with the dawn of the internet age, there would not only be more expectations for data sharing but patients would demand it.
Shockingly enough, it took until 2009 and the newly-elected President Barack Obama to begin to tackle this challenge in a systematic and effective way. The federal government began its push for the electronic health information exchange (HIE) in 2009 as part of the Obama administration’s economic stimulus. It offered $35 billion in incentives to healthcare providers to digitize all patient records and further the use of EHRs.
To demonstrate the need for this kind of initiative, it’s worth noting that even though electronic systems had floated around the industry since the 1960s, an estimated 63% of physicians were still communicating almost solely by fax as recently as 2012. The HITECH Act ultimately made huge gains in the adoption of EHRs to the extent that they became near-universal.
For all the fanfare, EHRs have helped improve care. For example, the EHR system can help physicians better manage care for patients with type 2 diabetes by:
- Generating lists of patients with diabetes
- Prompting care reminders for preventive care
- Educating patients on diabetes self-management
- Creating patient report cards
- Helping clinicians manage diabetes medications
EHRs are Everywhere but Barriers Still Exist
The success of the HITECH Act saw 96% of hospitals in the U.S. adopt a federally-tested and certified EHRs. Additionally, 80% of office-based physicians picked one up, too. However, the biggest issue with digitization has been in the realm of interoperability. EHRs shouldn’t be limited to collecting and storing information for a single organization: they can and should be also used to share it so that information can flow alongside patients. But by 2015, few physicians providers were able to share data with other organizations. In most cases, healthcare organizations can only share a specified amount of data with providers using the same EHR system.
Unfortunately, the problem is compounded by the fact that there are hundreds of available EHR products, and those are just the government-certified systems. With so many systems in place, it’s difficult for EHR developers to program interoperability: there are too many formats to contend with and even EHR systems that share platforms aren’t inherently shareable because healthcare organizations have them customized to their specific preferences.
There is also the issue of security. While patient privacy has been a stalwart of American healthcare for decades, the demand for the use of EHRs and internet sharing means that healthcare organizations also need full IT plans, including disaster recovery plans. The growing amount of data and the fact that it’s now all stuffed into software has seen a rise of cybercrime in healthcare specifically and the rest of the economy generally.
Opportunities for Improvement Are Here
The increased use of EHRs has led to a rise in fields like health informatics, which uses information technology to analyze health records. For health informatics professionals to do their job and for the field to reach its full potential, there needs to be an improvement in electronic health record optimization and usability. A big part of the problem that remains with EHRs and other tech is that physicians want new technology to meet the demands of their existing systems. The goal is to reduce the administrative burden of an EHR and free up more time for spending in face-to-face patient settings, rather than working on paperwork.
Some suggest further optimization for improving workflows, but that may only serve to damage interoperability further. One promising suggestion could flow through integrating new health IT tools into EHR systems that promote usability and place a renewed importance on clinical efficiency. For example, Vanderbilt University Medical Center (VUMC) chose an Epic EHR-integrated tool that allows clinicians to communicate and streamline care via their phones.
Ultimately, it seems that most improvements will be the product of communication between healthcare providers and EHR vendors. EHR developers can then be mindful of design within the clinical context, rather than solely looking at performance metrics.
What’s Next for Digitization?
Healthcare digitization is far from new: the first proto-EHRs made their way into tech-savvy offices in the 1960s and 1970s. Plus, we already know that today’s EHRs aren’t perfect: there’s a long way to go before they’re fully optimized.
Healthcare technology will continue to transform care both in the U.S. and around the world. And some of the biggest technologies currently on their way to reaching peak levels, as the Internet of Things and artificial intelligence, are likely to lead the way towards even greater digitization.
What will happen next? Only time and tech will tell, but if the huge strides made in the past ten years are any indication, the future looks bright for patients and physicians alike.
We’ve learned different things about EHR, from how the introduction of electronic health records into the healthcare industry has disrupted the process of storing patient data and the amount of data that can be accessed by a qualified specialist to different technologies that are been used. Now, its time to put the knowledge to practice.