panel on the future of electronic health records
TRANSCRIPT
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Karim Keshavjee, MSc, MD, MBA, CCFP, CPHIMS-‐CA
ITCH 2017 Feb 19, 2017 Victoria, BC
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¡ EHRs have pretty much failed all over the world (I’m talking about centralized medical records, not American physician medical records)
¡ Why? ¡ There are a thousand reasons, but
the #1 reason
Our collective hypotheses about EHRs are incorrect
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Doctors need data to look after patients (duh!) If we give data to them faster, patients will get better faster
(The “Replace Postal Service” Hypothesis of Better Care)
Let’s also make it Machine Readable so Computers can double-‐guess the doctors!
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¡ It may be true (unproven) ¡ But solving this problem has
NOT created enough value to justify the costs
¡ The experiences of the Health Information Exchanges (HIEs) in the US bears this out § HIEs are purer versions of the
“Replace Postal Service” with a lower cost structure than EHRs
§ They have also failed ¡ HL7 and Interoperability are
also massive failures –they are also based on the RPS hypothesis
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¡ We should be identifying and testing multiple hypotheses as we move forward
¡ But how will we know which one is the right one? ¡ Easy! ¡ Humans and systems are good at identifying value
and embrace it quickly § Christoph Lehmann pointed this out nicely in his Keynote: When IT goes ‘Viral’, you know you’re onto something
¡ What we need to do is try out a bunch of alternative ideas and see what works § But….where should we look for better ideas?
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Research
Study
Research
Stud
y
Synthesis
Researchers Academics Clinician-‐Scientists Clinicians Patients
Guidelines
The Healthcare Value Chain
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¡ The steps along the way by which we add value to raw materials
¡ In the Automotive Industry, they take iron from holes in the ground and make nice shiny cars which you can buy from your local neighborhood dealer § They don’t make you go to Northern Ontario to dig up the iron and smelt it yourself
¡ In healthcare, we discover new facts and treatments that we can deliver to patients
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¡ There are many stakeholders in the healthcare system who ADD value to the system
¡ When they’re left out of the IT equation, real value cannot be created
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Stakeholders
Researchers & Academics Providers
Patients
Ministries of Health
Systems Implementers
Guideline Implementers
Vendors
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¡ Lowering the costs of providing healthcare through: ¡ Predictive analytics –to provide care that matters to
patients and to allocate resources better § Everyone agrees there’s lots of waste in the system, but nobody knows where it is!
§ Will need researchers and data scientists to identify waste § More than anything, we need better measurements of “What is”
§ That’s what impressed me most about Christoph Lehmann’s presentation –not his great inventions, but the fact that he had such great granular data
¡ Shared data for coordinated care § Virtualization of care beyond bricks and mortar
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¡ Increased patient empowerment, access and control (mobile apps, block chain)
¡ Chronic disease logistics (lots of patients falling through the cracks)
¡ Ability to rapidly test hypotheses § Big data is meaningless without hypothesis testing
¡ Ability to share innovations using non-‐commercial dissemination mechanisms
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