Electronic Medical Records 1.0 (EMR 1.0) is still in its early development and implementation stages. Out near the edges, EMR 2.0 may already be evolving. First a little context:
System development 1.0 — the process leading to EMR 1.0 — follows a methodology something like this:
- Define a user group
- Determine their requirements
- Develop a system that satisfies those requirements
- Deliver sequential improvement, i.e., versions
System development 2.0 uses a different methodology:
- Define a capability
- Develop a system that exploits that capability
- Deliver it to the market place as “beta” version
- Work in the marketplace to learn what is really wanted and needed
- Stay in beta and make evolutionary enhancements as fast as you can
For this discussion, let’s use Microsoft Word as an example of a 1.0 system. The team in Redmond Washington developed Word 1.0. They then made minor changes, e.g., 1.1., 1.2. and a series of major changes that they stopped numbering several years ago. They listened to customers but the emphasis appears to have been to incorporate advances in the state of PC technology and the results of their own usability labs. In its era that worked and MS Word is the dominant system solution for word processing worldwide.
Electronic medical records (EMRs) – the real topic of this post – started as version 0.1. Basically a large number of standalone systems, most of which were developed for a single client or small group of clients. The primary focus was data capture and delivery within a single office of complex. There is still a very large number of those systems in use and for sale.
As the data was being captured it became apparent that sharing the data among a patient’s doctors would be valuable to the doctors and the patient. Efforts to add networking and sharing of information led to the dawn of EMR 1.0. The 1.0 model says, in effect: “We are developing an integrated system you can use when it is ready.” That version represents most of what is happening with EMRs today including the Administration’s inclusion of EMRs as part of the economic stimulus package and health care reform. A recent Twitter post defined the current status as: “an endless barrage of information and discussions and debates regarding various combinations of information.”
Google and Microsoft are, individually, taking 2.0 approaches. From here on I will use Google as my example because as a user of Google Health, I know more about and have easier access to what they are doing.
Google has taken some basic capabilities of the Internet and developed a rather simple model of a Person Health Record (PHR.) This 2.0 approach says and then asks “Here are some applications that could be part of a larger system. How can we work with you – patients and service providers – to make this and future enhancements useful to you? What role should we play? What role will you play?”
The market place is responding with uses that are almost all outside the current definition of the 1.0 version. Patients now have the option of linking 47 services to their Google Health profile. Whether or not these uses are valuable will be determined by the patients and the providers of services, not in some executive office or committee. Patients and providers will vote with their money, yes or no.