Clinicians Must Reinvent the Medical Record to Stimulate the Adoption of Electronic Medical Records

Blake Lesselroth, MD, MBI


February 22, 2008


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I believe individual physicians must intervene to catalyze the national adoption of electronic health records, or EHRs.

Research has shown that EHRs are slow to penetrate our healthcare landscape despite the potential benefits, including better quality, error reduction, and $80 billion annually in cost savings.[1,2,3,4] Although the federal government has begun investing in EHRs, widespread diffusion has been thwarted by misaligned financial incentives and a fragmented healthcare infrastructure.[5,6] More importantly, there has been cultural resistance among physicians citing issues of poor usability and awkward workflow design.[2,7,8,9]

Virtually every other industry has exploited technology and, in turn, captured a market premium. Apple changed multimedia; Amazon revolutionized retail; and Google democratized access to knowledge.[10] By contrast, EHR interfaces tend to be faithful representations of paper records. We must therefore ask how we can do better than paper if we are to capture the clinician's imagination. Three things must happen. First, the record must include tools, such as information filters, and preappraised resources to address pressures of a busy practice.[7] Second, we need context-dependent decision aids to support problem solving.[11] And third, we should borrow innovative ideas from other industries. What if clinical histories were depicted using multimedia, and therapeutic interventions were represented using graphics? What if patients updated their data using automated kiosks like patrons at an airport?

Technology has leveled the playing field, empowering individuals to develop and distribute new innovations. Now every provider is positioned to be a visionary and reimagine the EHR. This can be done several ways. Health policy advocates and federal administrators can finance and support open source development communities.[12] Clinical educators can include bioinformatics in their curriculum.[13] And frontline clinicians can avail themselves of the IT literature to inform product design and pilot new technology. The provider working at the intersection between technology and medicine is destined to reinvent the health record and drive adoption.

That's my opinion. I'm Dr. Blake Lesselroth, Portland Oregon VA Medical Center.




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