HIMSS/Physician IT Symposium: Healthcare enters era of profound change
LAS VEGAS—Speaking on "The Evolution from Transaction-Oriented to Intelligence-Oriented EHRs," John P. Glaser, PhD, CEO of Siemens Health Services business unit, said “we are entering an era of profound change,”  during his opening keynote at the Physician IT Symposium on Feb. 20, at the 2012 Healthcare Information and Management Systems Society (HIMSS) conference.

He said that reimbursement will be reduced, providers will have to prove they are delivering quality and efficient care and reimbursement is becoming holistic, or there will be one payment for all care.

In the past, the core focus of an EHR has been to optimize transactions such as writing prescriptions and documenting patient encounters. With the changes he predicted, “the emphasis on transactional orientation doesn’t go away.”

The problem now is that there is simply too much to know. For example, 700,000 journal articles were published on healthcare last year compared with just 400,000 articles 10 years ago. To manage that volume of knowledge, EHRs can guide clinicians’ diagnostic and therapeutic decisions, ensure the sequence of care and conform to performance contract requirements. They also can monitor the core decision-making process, expand the scope of decision-making data and support the interaction of care teams. This all leads to a shift to intelligence support, he said.

Key capabilities of EHRs going forward in this new era include the following:
  • Core set of expressions, such as  vocabularies, guidelines and order sets;
  • Process management infrastructure;
  • Inclusion of other actors, via patient engagement and health information exchange; and
  • “Novel” decision aids, such as predictive models, treatment guidance and intelligent displays of data.
All this helps identify events that indicate deviation from the standard of care which may require a provider’s attention.

This evolution to intelligence-oriented EHRs has its challenges, including the fact that effective use of intelligence requires supportive context, managing the base of knowledge is complex and current EHRs have varying abilities to become intelligence oriented. The shift “will not be trivial because healthcare has never been trivial,” Glaser said.