HITC2014
C. Peter
Waegemann
World Expert on EHRs
Past CEO, Medical Records Institute
Past Chair, mHealth Initiative
Past Chair, ANSI HISB (National
Standards Coordination)
Cited as one of the 20 selected
people “who make US healthcare
better” (HealthLeaders magazine)
© 2014 C. Peter Waegemann
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Lack of coordinated health record
◦ Move to specialists requires documentation
integration
◦ Recognition of documentation issues: Story-telling
and transcription
Meaningful Use
Requirements
CPRI
CHINs
CPR
Before
1987
1988
to
1991
RHIOs
HIEs
Improve
quality, safety,
efficiency, and
reduce health
disparities
EHR/EMR
1992
to
1994
1995
to
2001
COM.
Dotcom
DOT
Bubble
2002
to
2004
Study: 7% of
physicians
2005 and 2% of
to
hospitals
2008 have an EMR
No one has a
IOM Study
HITSP MRI complete
EHR
HIPAA
ONC CCHIT
Most RHIOs
Presidential
are not
Announcement Presidential
sustainable
Announcement
Engage
patients and
families
Improve care
coordination
Privacy and
security
Improve
population
and public
health
1988-1994
Computerbased Patient
Records
(CPRs)
Digitizing
the paper
record
1994-2000
Community
Health
Information
Networks
(CHINs)
Trying to
create
connectivity
2000-2008
Regional
Health
Information
Systems
(RHIOs)
Trying to
create
connectivity
2008-2014
Meaningfu
l Use
Health
Information
Exchanges
Increased
criticism
We need a
new strategy
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Focus on electronic medical record (within enterprises)
rather than the electronic health record with
interoperability between enterprises
Underestimation of documentation difficulties
Limited functionalities (MRI survey showed that 60% of
physicians were unhappy with functionality options)
Lack of user-friendliness: Many doctors hate EMR systems
Allowing companies with proprietary systems to close the
market
Using certification to push low-cost innovative companies
out to the market
Allowing a few standards organizations to dominate with
EDS messaging standards
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The Good
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Meaningful use instead of EHRs
Expect more reform efforts from future stages
Government incentives but…
Secret industry developments of digital society companies not
of HITC industry
The Bad
◦ Still not sufficient emphasis on ecare
◦ No bursting of the HIT industry bubble in sight
◦ The same players dominate the scene (new certification, etc)
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The Ugly
◦ Continuing support for outdated standards
◦ Lack of support for communication-enhanced healthcare
◦ Lack of new legislation
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Patients (slowly)
Users (?)
Cost pressures (?)
Employers (bad example: CPOE?)
Government incentives
Competition
Communication tools
Apple, Google, other non-HIT companies
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Original vision was for interoperable EHR
◦ Standardized documentation
◦ Standardized care
◦ Full data exchange
 (Wrong again) – Hope for CCR, CCD, but both
inadequate
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Interoperability through the PHR
◦ Mostly failure
◦ Successful PHR systems are on enterprise basis: VA,
Kaiser Permanente, etc.
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HIEs: Who knows what will work?
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Communication-enhanced healthcare
◦ New communication patterns from home care to text messagingrarely used
◦ Communication-based disease management – not accepted
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Transition of the scientific body of medicine-very little evidence
of a major shift despite 5000 medical apps
Use of artificial intelligence is very limited – Where are systems
based on
◦ Diagnostic algorithms? (used by military physicians in limited
applications) but should be a main research/development field
◦ Clinical big data for research?
◦ AI-based care plan developments and implementation?
◦ Global medical terminology project similar to Google’s data projects?
◦ Clinical natural language integrated into speech recognition? (Limited,
slow versions exist)
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Faster, easier documentation systems
◦ including interactive context-based documentation, structured text, speech
recognition, handheld systems
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Ease of use and implementation
Full interoperability of 4Ps
◦ (predictive, preventive, personalized, participatory)
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Better integration with care processes (e-care)
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Policies
Templates
References
Decision support
Communication
[email protected]
Please have a look at my website www.waegemann.net