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Escaping the EHR Trap Commentary 

Escaping the EHR Trap

In a recent article in the New England Journal of Medicine titled “Escaping the EHR Trap – the Future of Health IT“, Dr. Kenneth Mandi and Dr. Isaac Kohane present a strong argument for disruptive change in the EHR space as follows:

“Health IT vendors should adopt modern technologies wherever possible. Clinicians choosing products in order to participate in the Medicare and Medicaid EHR Incentive Programs should not be held hostage to EHRs that reduce their efficiency and strangle innovation. New companies will offer bundled, best-of-breed, interoperable, substitutable technologies — several of which are being developed with ONC funding — that can be optimized for use in healthcare improvement. Properly nurtured, these products will rapidly reach the market, effectively addressing the goals of ‘meaningful use’, signaling the post-EHR era, and returning to the innovative spirit of EHR pioneers.”

The full article is available here: New England Journal of Medicine

This article reads like an indictment of the EHR industry as a whole and the constraints that meaningful use and old technologies have brought to healthcare. The authors point out that technology in other industries has rapidly evolved to utilize cloud-based systems, mobile devices and connected architectures while the multi-million dollar EHR platforms dominating the US market remain bound to local servers, big IT budgets, and cumbersome hardware like Computers on Wheels (COWS).

As a startup in the Hospital Information System space, Electronic Health Records International (EHRI), a California company, is focused on the developing world instead of the US market. ‘While the US market is focused on big-dollar systems that are cumbersome to implement, the rest of the world is looking to bypass these technologies and jump to mobile applications’ says Nick Smith, CEO of EHRI. ‘We are able to innovate in this market and work toward a mobile, connected health record.’

‘The first step in this process is to move away from expensive computers for clinicians and to utilize mobile devices like tablets and cell phones. We should remember that the cell phone in your pocket has more computing power than the PC on your desk and can do a lot more tricks than your PC, not the least of which is to be connected anywhere in the world. This includes taking pictures, scanning bar codes, and running on the cell network if you are out of wifi coverage. With tablets now under $100, we can put 100 devices into the clinical environment for the cost of one COW. For a little more, these can be SIM-enabled so that they can run on the cell network if they are out of the hospital or the hospital’s network is down.’

In a recent discussion with a hospitalist using HarmoniMD, EHRI’s hospital electronic health record, the hospitalist pointed out that she keeps her tablet by her bedside in order to place orders and review labs and imaging when she is on call at night. In the developing world, this connectivity is even more important than in the US where desktop computers are more prevalent.

‘In the developing world, they still believe in return on investment (ROI) when it comes to technology instead of rewards from the feds. This forces software providers like us to build systems that are cheaper than paper’ Smith adds. ‘We like this approach because we have to innovate or die.’ As Charles Darwin pointed out ‘It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.’

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