Article

EHR The Holy Grail

EHR

[This article was published in the June 2011 issue of the eHEALTH Magazine (https://www.ehealthonline.org) ] EHR and PHRs will be accessible from anywhere and at any time thanks to Cloud Computing 3.0

EHR and PHRs will be accessible from anywhere and at any time thanks to Cloud Computing 3.0

dIgitalhealth

By Vamsi Chandra Kasivajjala

Think how exciting it would be to be able to take a medicine personalised for you which can cure a common cold in ten minutes or pneumonia in 4 hours or just eradicate hereditary diseases including Diabetes Mellitus, Schizophrenia, Alzheimer’s, RLS, etc. This is not fiction but a vision to make the impossible possible.”

dIgitalhealth

Eons ago, invention of language and writing tools saw the beginning of personal healthcare information being captured for important people mostly Emperors, Kings and Pharaohs; great scholars like Hippocrates, Susrutha, Peseshet, Esagil-kin-Apli, Rhazes, IbnSina, etc. documenting symptoms, remedies and various surgical and anatomical observations. It is said that the great Hippocrates captured personal health information so as to ensure that adverse reactions/interactions did not occur or recur based on the medications given. And this was way back in 440 BC, so Electronic Health Record (EHR) is not a new concept.

An EHR (also electronic patient record (EPR) or computerised patient record) is a record in digital format that is capable of being shared across different healthcare settings, by being embedded in network-connected enterprise-wide information systems. Such records may include a whole range of data in comprehensive or summary form, including demographics, medical history, medication and allergies, immunisation status, laboratory test results, radiology images, vital signs, personal stats like age and weight, and billing information.

Its purpose can be understood as a complete record of patient encounters that allows the automation and streamlining of the workflow in healthcare settings and increases safety through evidence-based decision support, quality management, and outcomes reporting.”

Medical technological advances like Genomics, Proteomics, RNAi, 256 Slice CT, elastic Ultrasounds, etc. are generating Terabytes of data, which needs to be converted into information and from that information it needs to be transformed into knowledge, which will then essentially save lives.

The Present

2011 is truly a watershed year, due to various reasons, but the most important of them being:

  • Kind of visibility that HITECH (ARRA) Act has given EHR/EMR to decision makers globally.

  • Cloud Computing is the buzz word of the IT industry.

  • Evidence based medicine, clinical decision support tools and vocabulary servers have truly come of age and are easy to implement and easier to integrate with.

  • HIE (Health Information Exchanges) and patient portals are making a mark.

  • In India, more and more citizens are having access to insurance and the payers are demanding structured clinical documentation as a part of the discharge summary which includes diagnosis, surgeon notes (if surgery is involved), progress notes, clinical events like lab and rad tests and their results, medication and IV details, etc.

  • Also, in India most of the providers are going in for accreditations like JCIA, NABH, NABL, CAP, ISO, etc. which also forces them to provide structured documentation as a part of their audits.

Medical tourism is picking up in India and slowly global standards for clinical documentation such as CCD (Continuity of Care Document) are slowly catching up.

The history of Medicine so far can be represented by the below diagram.

3300 “ 3000 BC 1000 BC 500 “ 460 BC 9th Century AD 11Century AD
Ayurvedic & Egyptian Medicine Babylonian & Hebrew Medicine Chinese, Greek & Roman Medicine Persian & Islamic Medicine European Medicine (Medi)
12thCentury AD 1676 AD 1847 “ 1865 AD 1882 AD 1895 “ 1899 AD
European Medicine (Early Modern) Microbiology Germ Theory, Early Genetics & Eugenics Bacteriology Radiology & Psychiatry
1901 “ 1929 AD 1928 AD 1998 AD 2003 AD 2012 AD
Serology & Virology Penicillin Embryonic Stem Cell Therapy Human Genome Project Cloud Based EHR

Due to the above reasons and more, EHR/EMR is truly a must buy on every CIO/CXO’s shopping list.

And in India, unlike its Western (USA, Western Europe, Australia) and APAC counterparts; focus was more on revenue related aspects like billing, charge posting, interfacing with finance (AR and GL), but now slowly aspects like clinical documentation, order entry, structured reports from EHR like discharge summary, case notes and more are becoming common requirements. Similar to the Western countries, the need is stemming from the acute pressure from payers and patients alike.

After all, a typical educated patient searches Google or Bing on the symptoms’ and probable diagnosis before he visits his/her doctor. Today it is common that an expectant mother and her husband have more questions to ask compared to what a doctor had to answer a decade ago. This means the need for more patient education material and access to patient portal and PHR are becoming a necessity than want.

Welcome to the age of Healthcare Information Technology!!!

The Future

Whether you call it Gartner’s CPR Generation 5 or take a leaf out of Michael Crichton’s Next or it could be our favorite Jurassic Park movie.

The future of EHR and PHRs will be based on Clinical Genomics and Proteomics; drug delivery will have Nanotechnology as an integral part; Robotic surgeries will be a common phenomenon; petabytes of data will be crunched in a matter of minutes if not seconds. This is OUR FUTURE!

The future EHRs will be based upon the following core components:

  • A clinical inference engine which can compute all kinds of interactions including drug to drug, drug to food, drug to lab, drug to diagnosis, drug dosage alerts, drug to gene, drug to allergy, and more.
  • Inbuilt vocabulary server which can understand whether you call CABG, coronary bypass, coronary bypass surgery, coronary artery bypass graft or open heart surgery.  The systems will have the ability to understand patterns and match them without human intervention.
  • Online interfaces to Insurance company systems to ensure that the meds or other orders are covered and this will be handled almost instantaneously.
  • Crunching engine “ which will have the capability to process Petabytes of data to provide the right Evidence based medicine and well defined Pathways which use the state of the art clinical knowledge management, workflow and business rules engines.
  • A seamless graphical user interface with inbuilt speech recognition and facial recognition technologies, which would ensure that the clinicians do not have to look at their monitors while trying to communicate or while diagnosing their patients.
  • Repurpose engine, which would be able to provide true contextual search, for example: if a Cardiologist searches for ‘CAR’, the top results would be to do with Cardiology such as Digoxin or Warfarin; Atrial Fibrillation or Tachycardia; Acute Myocardial Infarction or Ischemic Cardiac diseases. And, also the engine would be able to provide the interfaces over browsers or any kind of mobile communication devices.
  • Communication server which would be able to print reports, fax them, send SMS alerts and even call users or patients based on rules.

EHR and PHRs will be accessible from anywhere and at any time thanks to Cloud Computing 3.0. The probability of giving the wrong medications or an anaphylactic reaction occurring due to a drug-allergy reaction would be miniscule. Most of our mobile devices would have auto medication dispensing units built into them especially for geriatric patients and which are connected to our PHRs seamlessly. Our vital signs would be monitored unobtrusively and paramedics would arrive before a serious medical mishap occurs. The world of ‘Minority Report’ is probably not too far away.

True social computing in combination with tele-presence will make the future of telemedicine much more than what it is today. And it goes without saying that, all the information would be provided through EHRs and PHRs.

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