Past, Present, Future December 6, 2004 Past, Present, Future December 6, 2004 Physicians, Hospitals and the Evolution of Electronic Medical Records (EMR)

Hard Realities Estimates 44,000 to 98,000 people die each year from medical mistakes 45 million people have no health insurance $140 billion could be saved annually by shifting from paper to digital records Kohn, et. al., To Err is Human Building a Safer Health System Bartholomew, “ Eh, What ’ s up Doc? ” 80. Estimates 44,000 to 98,000 people die each year from medical mistakes 45 million people have no health insurance $140 billion could be saved annually by shifting from paper to digital records Kohn, et. al., To Err is Human Building a Safer Health System Bartholomew, “ Eh, What ’ s up Doc? ” 80.

What is making this process so difficult?

Overview The Past to 1960 The Present to 2004 The Future to 2025 The Past to 1960 The Present to 2004 The Future to 2025

1960 An Explosion of Advancement Science Society Medical Technology 1900

1900 to Organization Physicians become the unquestioned clinical authority Hospitals become their stage America becomes a society of believers in science and the miracle of medicine Physicians become the unquestioned clinical authority Hospitals become their stage America becomes a society of believers in science and the miracle of medicine

What information was shared in the past? No universal format before 1950 Content reflects the authority of physicians Not used to bill insurance Used by doctors to consult with doctors “ Structuration theory” - organization members use their power to control decision making. Communications achieve a life of their own. No universal format before 1950 Content reflects the authority of physicians Not used to bill insurance Used by doctors to consult with doctors “ Structuration theory” - organization members use their power to control decision making. Communications achieve a life of their own.

Hard Realities Big Questions Science Society Medical Technology Knowledge, technology, and mistakes are expensive Who is entitled? Who pays? Knowledge, technology, and mistakes are expensive Who is entitled? Who pays?

1980 to Challenges Stakeholders in EMR Patients Doctors Lawyers Hospitals IT Sector Pharmaceutical Industry Private Insurance Government

What is making it so difficult to share information? “Law of suppression” - ensures that any new communications will take decades to be diffused

Lack of regulatory requirement to make records interoperable EMR emerging social necessity Lack of metrics to measure ROI 2004 Existing records are fragmented Lack of standards Increasing complexity of physician hospital relationships 1980

Challenges of the physician hospital relationship Partner Employee Competitor Customer Hospital

Integrated, Networked, and Accountable

2010 to Accountability A new era enabled by EMR –Ability to record, measure, and control clinical and financial performance –Tool to assign care based on ability to pay Predicted cost –Health care consumes $6.6 Trillion annually (22% of GDP) –93 Million Americans will have no health insurance “Tragedy of the commons” - the result of freedom to use a commonly held resource without regulation Rowley, William R. “Healthcare 20025: Alternative Views and Underlying Values.” Foresight: Journal of Futures Studies, Strategic Thinking and Policy 5, no 5 (2025): A new era enabled by EMR –Ability to record, measure, and control clinical and financial performance –Tool to assign care based on ability to pay Predicted cost –Health care consumes $6.6 Trillion annually (22% of GDP) –93 Million Americans will have no health insurance “Tragedy of the commons” - the result of freedom to use a commonly held resource without regulation Rowley, William R. “Healthcare 20025: Alternative Views and Underlying Values.” Foresight: Journal of Futures Studies, Strategic Thinking and Policy 5, no 5 (2025):

Conclusion Limited content of medical records reflected the authority of the physician who created them Adoption of EMR is being suppressed by the competing interests of multiple stake holders Supervening social necessity will achieve diffusion of EMR, accountability in health care and rationing of health care by the private sector Limited content of medical records reflected the authority of the physician who created them Adoption of EMR is being suppressed by the competing interests of multiple stake holders Supervening social necessity will achieve diffusion of EMR, accountability in health care and rationing of health care by the private sector