Leaving aside the troubled business side of medicine, electronic medical records are supposed to ease and simplify the capture, analysis and sharing of clinical information, by utilizing computer software tools. Computers have eased and simplified the capture, analysis and sharing of financial information, supply chain information, manufacturing information, transportation information, and every other type of industrial information you can think of, so why not medical information? Before you go pointing out that clinical information is highly variable and so very unique to the individual, please consider that computers have simplified and eased capture, analysis and sharing of personal information of all sorts from chatting and accessorizing outfits, to making friends and asking a pretty girl out on a date. Surely, nothing is more unique and personal than finding your soul mate. Not even health care.
If a physician practicing medicine in the U.S. today desires to ease and simplify the capture, analysis and sharing of clinical information, he or she can choose from a large assortment of computer software tools, better known as EHRs, all carefully examined and certified by government sanctioned entities to be capable of easing and simplifying these tasks, and as Pete Seeger might have said, “there's a green one and a pink one and a blue one and a yellow one, and they're all made out of ticky tacky and they all look just the same”. To the dismay of regulatory and certifying authorities, most physicians who are willy nilly adopting these tools, under threat of financial fines and penalties, continue to grumble that the capture, analysis and sharing of clinical information is neither eased nor simplified by EHRs, and quite the opposite is true.
This strange situation can be, and often is, dismissed as due to physicians being technophobes or just unwilling to do their share in promoting beneficial health reforms. To support these specious arguments, the regulators are constantly parading a handful of doctors who found happiness and efficiency in their EHRs. Unexplainable? Not really. There are always a few lucky folks for whom one-size tee shirts fit as perfectly as if the rag was tailored just for them, while the rest of us have to tuck it in, tie it in the back, cut it off, or pull at the sides to make it stretch, and in all cases it ends up looking like someone else’s garment. A quick look at what is driving health care costs up reveals that physicians as a group are cheerfully adopting things like magnetic resonance, computed tomography, image guided radiation, proton beam therapy, laser surgery, robotic this or that, and a host of other high tech tools that would terrify the average technophobe into crawling under the first available rock. So why is health information technology so different? Or is it?
- epocrates, the drug reference software boasts 50% of physicians in the U.S. as its users. epocrates has been steadily growing since 1998 and is practically a household name when it comes to medications advice. It is available on iPhones, iPads and mobile Android devices and it has expanded far beyond just lists of indications and contraindications for prescription drugs.
- UpToDate needs no introduction either. The widely used electronic clinical decision support system has been in existence for over 20 years and you would be hard pressed to find an academic institution that is not subscribing to its content and tools, both in the U.S. and the rest of the world. Like epocrates, UpToDate is available on the web and on all fashionable mobile devices.
- Doximity is a relatively new kid on the block, and a very interesting one to boot. Only 3 years old and already claiming to have “crossed the 200,000 member milestone”. Doximity is a communications platform for physicians allowing members to securely exchange messages, including clinical information, and make referrals or obtain ad-hoc consultations from colleagues. Sort of like a social network on steroids, and of course it is available on mobile phones and tablets too.
Sadly, this crescendo of innovation is very unlikely though, because unless the new software is a clone of some primordial EMR, or parts thereof, and unless it conforms to government devised ways of doing things, most prospective customers will be forced to choose between a new and unknown product and the piles of cash thrown at them by regulators. If say, our imaginary Charximity developers come up with a quick and elegant way to record a dynamically defined set of information, and package it in a small, nimble and universal format that lends itself to being securely moved around the private networks of the fabled Patximity and real Doximity, in a most expedient way, chances are great that this cool innovation will fail to thrive because it can’t inform regulators on Johnny’s smoking status or Grandpa Joe’s prostate trouble, in an exhaustive XML format passed around through interminable chains of certified intermediaries on the federally secured national health information network. The good news is that one day checkboxes and dropdown lists will only exist at the Smithsonian, and good technology will prevail in the end. The bad news is that the end is being pushed further and further away with each additional Meaningful Use stage.