By Dr Tom Foley, Dr Fergus Fairmichael.
David W. Bates, MD, MSc, is Senior Vice President and Chief Innovation Officer for Brigham and Women’s Hospital. He is a practicing general internist and maintains his positions as Chief of the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital, Professor of Medicine at Harvard Medical School, and Professor of Health Policy and Management at the Harvard School of Public Health, where he co-directs the Program in Clinical Effectiveness. He also serves as Medical Director of Clinical and Quality Analysis, Information Systems for Partners Healthcare System.
Adoption of Electronic Health Records
There has been significant adoption of electronic health records over the last 5 years in the US
• The Affordable Care Act and Meaningful Use incentives in the US have meant that adoption has been more complete and that systems have enjoyed more functionality compared with the UK
• Incentives help to place the goal posts in the right direction and provide a foundation to build upon, but they are not sufficient in themselves
There are multiple near term benefits of EHRs:
• Medication safety is often the first noticeable benefit
• It becomes easier to identify patients who should be included on a more appropriate pathway
• Easier collection of data on standards of care
• Increased efficiency
◦ For example, automation and prompts regarding tests due for preventative measures
◦ Tracking of care for patients with chronic conditions. Chronic conditions are a huge burden on cost in healthcare and there is a lot of opportunity to improve performance by making processes more efficient
These need to be measured as a routine and in a standardised way in order to derive any meaning. Patient reported outcomes are particularly important because they can provide a unique set of information, and can be collected in cost effective and convenient settings.
Areas of potential development
• There is a lot of information from social media that could be highly predictive of how well patients may fare with regard to their health
• It is clear that we stand to gain a lot of valuable information from these sources
• We could potentially see more value from this source than from genomics
• There needs to be a societal discussion as to what data it is acceptable to mine
Big data methodologies would need to be developed further to process such vast quantities of data, but such techniques may become feasible in the next 5-10 years
Disruptive areas of research
Wearable technology is becoming an incredibly powerful tool. These devices may prove useful, in particular in enabling patients to manage themselves. Vital signs, etc., can be recorded in a continuous way and tools can be developed to sift through this data.
There remains some questions about who mobile technology will benefit most. We have seen that those who engage most with mobile devices tend to be the most disadvantaged patients and are not necessarily the groups that would benefit the most from such technology.
The next big incremental improvement could be in monitoring technologies, e.g. “smart sheets” on patient beds that measure vital signs. Advances in analytics will help to reduce false positive alarms. Communication technology may offer a means to alert staff to changes in a patient’s condition by communicating straight to a clinician’s smart phone.
Innovation in healthcare technology is usually driven by the market. We have seen this in countries such as the US and Israel, more than in the UK. Often the most disruptive technology will come from outside of the healthcare market, but will be adapted into it.
Learning Health Systems will make the doctor/patient relationship more egalitarian.
The patient role will change as they become more empowered within the system.
Healthcare systems need to focus on moving people up the activation/engagement scale. There are three levels of the activation scale:
1. Those who want to understand and manage their own care
2. Those who want to understand what is happening, but be told what they should do
3. Those who do not want to understand or engage at all
Information needs to be presented to people in a way that they will be able to use themselves.
Behaviour change science is becoming increasingly recognised as being critical in bringing knowledge into practice.