Sunday, October 5, 2014

Epic, Ebola, and the 1%

OK.  Maybe it's not the 1% and closer to the 3%.  The worthy percentage of hospitals in America that are wise enough, smart enough, and rich enough to have top of the line EHRs implemented.  I'm not just talking about the greatest Health IT vendor on the planet, Epic, but also others in this category from Cerner to Allscripts to Meditech (who might be equally great...or not).

I've been around the block to know a lot of great organizations with great leaders have put their faith in these informations systems and for the record they are a TON better than they were a decade ago.  In fact, I would offer that these systems categorically have exceeded the capabilities of their category.  They are the best electronic medical record systems we could have ever imagined.

They have done what they were built to do: replace the paper chart.  In so many ways, they are better than the paper chart.  So many that it is difficult to list.  Why would anyone every need a paper chart when you have an EHR?   Quite simply you don't.

The problem for Epic and Ebola and for that matter for any EHR and any disease is that no EHR was ever designed for the express purpose of helping doctor's treat patients better.  

No EHR vendor has spent R&D developing the best clinical pathways for the treatment of aneurisms or for that matter prostate cancer.  There is no part of the EHR that brings together the necessary lab results, medication list, surgical and family history, and for that matter recent literature and clinical guidelines on to one screen so that the doctor & care team can best manage a condition.

So is it difficult to imagine, that when 1 patient out of 75,000 patients you will see in your ER this year happens to have a rare condition that you have never seen before in your hospital's history that your EMR doesn't have special software designed to help the care team manage it.

Hell, your EHR doesn't have a screen that brings all of the relevant information together for the top 5 conditions that you see in your ER.  Now, the vendors will disagree with me, because all of this information is in the system (somewhere) and clinicians should be trained to know how to find what they're looking for (this is why physicians hate EHRs).

It is not Epic's fault that they provided an EHR that didn't help a hospital efficiently take care of an Ebola patient.

  1. They never promised us that they would help us treat patients better through the use of their software.
  2. They give us features that if we want to turn on might help care teams treat patients better as long as we don't configure the features in a way that don't.
  3. Care teams are free to try to come up with ideas on how software that was fundamentally designed to replace paper could help us achieve better outcomes with patients.
An EHR was designed to keep a record of care.  In fact, Epic succeeded at that 100%.  We know what happened in that ER much better now than if we had a paper record.  Congratulations.

For the record, Epic (and other vendors) have sent us complete procedures (suggestions) on the many features that exist within our purchased software that could be set-up to better manage the immense Ebola risk.  I will get to work on that right after I review the section on how to manage stroke patients or patients on Heparin.

October 2014.  State of the EHR industry:  All of the users of EHRs brainstorm the best ideas on how to use the many features given to us by the vendors to purposefully improve patient care.   We're trying hard but it's slow going.

The Feeling Begins....

The name of the first track from the Soundtrack to the Last Temptation of of Peter Gabriel's best works.  This blog is clearly not worthy of sharing the same title.

However, as will be common for this blog, the ideas will quite often be borrowed.  Think of this blog as more of a mix tape rather than original music.   Many times, the thoughts will be more emotional and aspirational rather than rational.  The punctuation will likely be flawed as much as some of the references.

This is not a blog to motivate or to tell the world how great I am/we are.  Rather, in this very complex inter web, there is that chance that when I scream my own very interesting thoughts out into the ether, I might attract a few equally interesting thoughts back.  Somewhere in that moment, perhaps my hopes, fears and frustrations will have some company.

The purpose of this blog is to discuss topics in healthcare information technology.  I will not share with you what I have learned at the supermarket, or raising my children, or taking a train in India.

I am stuck in moment.  The moment when so much is possible, yet it hasn't happened yet.  I'm firmly convinced that the revolution will come....just not where we are looking for it.