Innovation in healthcare is taking many forms, from meshing big data and design thinking to reduce hospital infections to personalized medicine based on a patient’s genomic profile. Michael Apkon ’02, president and CEO of the Hospital for Sick Children in Toronto, says that effective innovations are ones that “create value for patients and improve quality and reduce costs through a more integrated and coordinated approach.”
The process of digitizing medical information provides insights into both the promise and the challenges in making systemic improvements. Electronic medical records offer a cornucopia of theoretical benefits: Completeness and portability that would let teams of doctors coordinate immediate care while keeping a view of the patient’s long-term health. Ease of seeking a second opinion or changing providers. An incomparable source of public health data that researchers, providers, insurers, and policy wonks could use to drive toward more effective treatments—both in cost and health outcomes. But this promise has been just over the horizon for decades.
The potential of electronic medical records was one of the innovations discussed in a recent Yale SOM webinar. The conversation was moderated by Richard Foster, a lecturer in management at Yale SOM. Along with Apkon, the panelists included Michael Sherling ’02, chief medical officer and co-founder of Modernizing Medicine, which produces an iPad-based “electronic medical assistant”; Brian Kim ’00, head of strategy and marketing for biosimilars at Boehringer Ingelheim; and Rosalyn Cama, president and principal interior designer for Cama Inc., which focuses on improving healthcare environments.
Many doctors remain skeptical of electronic medical records (including those who have adopted them) because they create additional steps for clinicians rather than replacing or streamlining existing processes. Cama pointed out that clinicians typically spend their days moving from room to room seeing patients, so that electronic medical records systems built for desktop computers are disruptive, no matter how many PCs are squeezed into hallways and exam rooms. Handheld devices offer an obvious alternative. “This is a perfect example of where design of the built environment will impact improvement,” she said.
Another issue with electronic medical record systems, Sherling said, is that too many are aimed at all 800,000 doctors in the country, resulting in systems that require a tremendous amount of customization by physicians. Each of the iPad-based programs produced by Sherling’s company is designed for a specific medical specialty, he said, because the software has to be designed to include a tremendous amount of medical knowledge and understanding of the doctor’s workflow. “It’s not as easy as programming away at it. You need physicians involved every step of the way,” he said. Modernizing Medicine’s first product, aimed at dermatologists, was being used by 27% of physicians in the specialty within four years of launch—because, Sherling asserted, it actually saves doctors time.
Gathering medical data in digital form is one big hurdle; making it shareable is another. Kim pointed out healthcare providers compete with each other. If medical records move seamlessly with the patient, it removes an impediment to patients leaving. “There are economic incentives in place already where you don’t want to have interoperability,” he said.
The goal is medical records that are secure but also shareable for all stakeholders. Healthcare portals, Apkon said, have offered a preliminary step toward bringing patients into the equation. For now they typically offer patients web-based access to interactions with a provider and/or insurer, but they could eventually be a hub for records. Apkon explained that health portals have been successful for the same reason Modernizing Medicine has been: because they are more efficient than existing alternatives. “People use portals because it’s the way they make appointments, it’s the way they get prescriptions renewed, it’s the way they check on communication from the doctor,” he said.
While electronic medical records are a focus of innovation today, Cama said, the next step will be to use technology to allow care to be provided remotely. “The marriage of architecture and technology will begin to shape the way human interaction occurs.”