Although the first electronic health record (EHR) systems appeared as far back as the 1960s and the Institute of Medicine advocated for EHRs in the 1990s, their widespread adoption didn’t heat up until 2009. That’s when Congress passed the Health Information Technology for Economic and Clinical Health Act, which earmarked $30 billion for the widespread adoption of EHR technology.
As health systems move toward an EHR model of care, what can we expect in the future? Here, three leading experts weigh in on what EHRs may look like by 2030.
1. Richer, More In-Depth Content
While current EHRs tend to reflect the same paper records they’ve replaced, future EHRs may provide a more layered representation of a person’s history, predicts William C. Dunagan, MD, MS, professor of medicine at the Washington University School of Medicine in St. Louis, senior vice president and chief clinical officer for BJC HealthCare, and director of BJC’s Center for Clinical Excellence. “You would be able to drill down to the level of detail you need, and all previous history relevant to a diagnosis, condition or procedure might be linked to the current record, along with much richer photographic documentation,” he says. Disease or surgical and procedural histories might be represented by a “map” of the patient with clickable information points at the sites of previous interventions, predicts Dr. Dunagan.
2. A Comprehensive Narrative
Similarly, Keith F. Woeltje, MD, PhD, professor of medicine at the School of Medicine and vice president and chief medical information officer for BJC HealthCare, says he hopes to see future EHRs better focused on the narrative of a patient’s presentation. Today, he explains, much of the input for EHRs is based on billing codes and appears as discreet, often repetitive data. Already, he notes, some systems are using a wiki-type interface that allows different providers to document a person’s hospital care throughout the day. “It’s more collaborative and assesses the flow of the patient through the hospital and through their stay, giving a better sense of the patient’s journey.”
3. More Precise Medicine
As EHRs have evolved, the ability to do more than simply record events, findings and opinions has increased, Dr. Dunagan says. “Computer-assisted analysis and decision support will be the defining characteristic of successful EHRs,” he says.
Through informatics tools, that decision support will allow clinicians to tap into a vast database of patients, facilitating precision medicine, says Albert M. Lai, PhD, associate professor and chief research information officer at the School of Medicine, and adjunct assistant professor in the Department of Biomedical Informatics at Ohio State University. “It will be easier to ask and answer questions using the electronic health records system. For example, ‘What other patients look like the one I have in front of me?’” Physicians can then discover how possible treatments might affect prognosis.
4. Increased Patient Engagement
EHRs will enhance patient engagement as they become integral to the patient experience, Dr. Lai says. In the future, he envisions individuals answering questions before they arrive at the clinic. Their appointment would then be based on the data they provided. “I think that the patient portal, which is an aspect of the electronic health record, will be much easier to use,” Dr. Lai adds.
5. A Greater Reach for Remote Medicine
EHRs will be better integrated into telemedicine, predicts Dr. Lai. “Right now they are typically stand-alone systems,” he says. “I think that the two will become more and more intertwined.” As a result, providers will be able to provide care anytime, no matter where the patient is.
To further enhance telemedicine, home medical devices such as fitness trackers might feed information into the EHR automatically, Dr. Woeltje says. “By having those key data available electronically,” he says, “that will help obviate the need to go to the office, allowing for remote monitoring.”
6. Powerful Partnerships
The School of Medicine and BJC HealthCare are currently implementing the Epic EHR system, incorporating clinical documentation from all areas of patient care into one database. This will allow the two organizations to have an even greater collaboration, Dr. Woeltje says. For example, diabetes patients receiving care through BJC HealthCare could be enrolled in a study at the School of Medicine that uses a home monitoring device to record data electronically. Results of the study could be used to further refine treatment for patients in the health system.
And while the future is always challenging to predict, Dr. Woeltje is cautiously optimistic that at least some of the hoped-for benefits will be realized. “Will we be there in 2030? Probably not,” he says. “Will we be a substantial way along the way from here to there? I think so.”
“Computer-assisted analysis and decision support will be the defining characteristic of successful EHRs,” says Dr. Dunagan.