Electronic medical records provide value at several levels. The most basic level is a specific doctor/patient relationship. Above that is care by a doctor team and a patient dealing with a complex medical issue such as cancer. Above that is a database derived from those records from multiple doctors and teams.
Large databases already exist. The Veterans Administration has one and so does Kaiser. Just three vendors—Meditech, McKesson, and Cerner—serve more than half of the acute care hospitals that have vendor systems. Practice Fusion is the dominant service in doctors’ offices with more than five million patient records.
We are already beginning to see more and better data quicker.
A large database—more data–has a number of advantages. First, you can look at issues that affect only a very small percent of the total population and still have enough cases to draw reasonable conclusions. Second, you can define “control groups” with very similar characteristics who are not affected by whatever you are studying so you can begin to look for potential causes.
Data collected by professionally trained doctors and nurses in the normal course of their medical practice using structured formats is more reliable and easier to analyze—better data–than most of today’s studies that rely on interviews and limited records. Practice-derived data will be adequate for some studies and will provide the starting point for others. One possibility is to use practice data to find patients of interest and then work with them and their doctors to obtain additional information. The Web site PatientsLikeMe.com has already demonstrated the willingness of people to share treatment and symptom information when they see value to themselves and others.
The processes of most of today’s research require a significant period of time between data collection and publication. Large databases support near real-time analysis of data and reporting—better data quicker. Two illustrations are provided by Practice Fusion’s response to the N1H1 flu using the guidelines published by the CDC and their posting of data on Microsoft’s Azure MarketPlace.
What can happen if we get better data quicker? Here is some of what we can expect:
- Widespread use of standardized quantifiable measures of service, effectiveness and safety; healthcare is not totally quantifiable, but much of it is and the quantifiable part can provide guidance about what works best under what circumstances.
- Identification of significant risks and steps to reduce them such as the risks associated with center line catheter infection.
- New ways to identify, manage, and respond to the potential risks associated with new medications and new uses for existing medications.
- Significant impacts on medical litigation including reductions in the actual harm done to patients with subsequent reductions in compensatory damages plus better standards of care and records to reduce, and in some cases eliminate, punitive damages.
More and better data quicker from EHRs will be one of the major medical breakthroughs in the next few years.
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