Doctors lack an analytic engine: Why we need EMR 3.0

Doctors lack an analytic engine: Why we need EMR 3.0

Health information technology (HIT) has had a tremendous – and mostly positive — impact on our systems for recording, delivering, monitoring, and reporting the healthcare and services we deliver.

Like most of my colleagues, I can tick off at least five or six large “pioneer” corporations – companies like Epic, Cerner, Allscripts, Siemens – in the forefront of the technology explosion that yielded important tools for advancing the field of electronic medical records (EMRs).

Although research into their impact on quality of care and patient safety remains modest and is often controversial, these tools have eliminated considerable issues related to poor physician handwriting and have greatly improved internal and external provider communications and reporting.

The question percolating in my mind has to do with where healthcare is headed and what is being done in the HIT arena to help providers meet the challenges posed by health reform.

Accountability is the chief underpinning of the new models of care promulgated by the Affordable Care Act (e.g., Accountable Care Organizations and Patient-Centered Medical Home) – and it is also an expectation for all healthcare providers and organizations.

Accountability requires a more well-rounded view of quality and efficiency of patient care that takes into account combined clinical, administrative, and financial data.

The problem – EMRs are essentially electronic charts, but what we need going forward is a tool to promote accountability and measurement of quality and safety.

In practical terms, clinicians need an analytic engine that sits on top of the EMR, one that is capable of sweeping up clinical data and converting it to information that will improve clinical decision making.

HIT companies are scrambling to create an “EMR 3.0″ analytic engine for accountability (e.g., an analytic tool that monitors gaps in care for a provider’s population of patients with diabetes), but this is more challenging than it may seem on the surface.

As an “accountable” primary care clinician in the modern healthcare environment, I need:

  • A registry to monitor and evaluate my patients – not just individually but as a population
  • Relevant data on my patients who share a specific diagnosis such as hypertension or asthma
  • Information on how my medical management and patient outcomes compare with other local practices
  • Information on where my practice stands in comparison with national benchmarks

Most important, clinicians like me should be able to accomplish these functions easily online.

Now in her third year of medical school, one of my twin daughters has done rotations at three different hospitals, each with a different EMR system. Having grown up using computers, she mastered each of them with ease.

If it takes six clicks of a mouse to access what we need, there is no hope for those of us over the age of 50.

David B. Nash is Founding Dean of the Jefferson School of Population Health at Thomas Jefferson University and blogs at Nash on Health Policy.

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  • southerndoc1

    “Health information technology (HIT) has had a tremendous – and mostly positive — impact on our systems for recording, delivering, monitoring, and reporting the healthcare and services we deliver.”

    Well, if you start with a blatant lie like that, I’m not too interested in reading what follows.

    • Stuart Showalter

      I would hate to see the state of human progress if everyone share your “open minded” viewpoint.

      • southerndoc1

        Well, I’m certainly not “open minded” about statements that are contradicted by the evidence.
        All HIT has done so far is increase costs with no improvement in quality. It has tremendous potential, but the way it is being deployed in this country guarantees that that potential will not be realized.

  • Ahmed Mohareb

    The good news is that we already have the analytical software in place to assist with clinical decision making and quality management, control, & improvement (E.g. Minitab) The idea now is to integrate this capability with the next generation of EMRs.


    EMR will add many advantages to healthcare practice world over in time to come, if it has not already. Not to mention any particular product name of EMR, certainly it will be the future of care to patients.

    From poor handwriting of physician, leading to medication errors to poor concentration on lately developed clinical features or missing on latest investigation report, human error has been identified as the most common cause of patient care mishaps.

    As one comment rightly picked up, no system will work well if it is fed with garbage; whether it is manually run or highly advanced and sophisticated. As we all agree, most of medical errors occur due to human factor.

    EMR; what we expect to emerge is meant for providing a service over and above the average scope which is far superior to line of average thinking as one mentioned. It means well to pick the gap in patient care stream, provide support to the clinical decision making process and to keep eye on performance of physicina and the behavior of patient population in expected parameters.
    Sooner or later, the comprehensive EMR solution will provide meaningful answers to issues raised by the writer.

  • Donald Tex Bryant

    Recently the IOM’s report “Best Care at Lower Cost” cited the results of Sweden’s use of disease registries. In Sweden there are 90 government supported registries covering a broad range of medical conditions. The registry for acute myocardial infarction that collects data from all of the major hospitals in the country has been used to reduce by 65% the 30 day mortality rate for patients who had suffered an acute heart attack and reduced by 49% the one year mortality rate. Obviously, the Swedish know how to collect data electronically and put it to good use. I think that it would be a great idea if states working with organizations such as the American Hospital Association and state Health Departments set up such registries to improve the collective health of those with chronic conditions such as hypertension and diabetes. It could save the states a great deal of money in healthcare costs.

  • Jason Ensminger

    Evidenced based medical decision making is a feature that is lacking from even the best EHR’s today. This definitely needs to be implemented and in a way that is unobtrusive but also tracks usage and outcomes. This would be a major breakthrough as the feedback on outcomes would allow the healthcare establishment to evaluate the efficacy of national recommendations. In essence, it would make every physician an investigator in that largest clinical trial ever seen and provide ‘free’ research for the benefit of everyone.

  • Docbart

    We have spent billions of dollars and untold hours on EMR. Solving handwriting issues and communications is what we have to show for all that? Why not just pay a small incentive to use print instead of cursive handwriting? A phone call between physicians works much better than faxing a printout of office notes with pages of boilerplate prose meant to justify a billing code. Is EMR really a good use of our time and money? So far, it is not.

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