I've heard it said that to an optimist, half a glass of water is half-full, to the pessimist it's half-empty and to an engineer, the glass is twice as big as it needs to be.
What got me thinking about this was a panel discussion I watched the other entitled, "What's Ahead for EHRs.” During the panel, three of the discussants were physicians and one was PhD, all with years of experience working with EHRs in the context of prominent healthcare organizations, including Kaiser and the Veterans Administration. They all seemed to fall into the optimist category, quite realistic about some of the challenges that lied ahead but very excited about the possibilities. All three worked for organizations that appear to share their goals and have been very successful, not only at dealing with the technology but in improving organizational performance and improving quality.
It is notable that some of the most impressive results have been obtained by Kaiser Permanente and the U.S. Department of Veterans Affairs (VA). Both are organizations that have effectively separated physician compensation from what many privates used to refer to as "production.” It was pointed out that the full potential of EHRs will not be realized by practices where income remains tied to the number of face-to-face encounters that can be squeezed into a day. Quality improvement and cost reductions seem to require that physicians spend part of their day proactively managing patients by reviewing data and communicating with patients in ways that do not need an encounter, activities that will not be embraced if they cause a reduction in income.
Interoperability, that elusive topic that has provided the backdrop for the last several articles, was discussed in some depth, and it is clear that a number of challenges still remain. What needs to be exchanged? How dependent is it on standards? What about privacy? How can a group involve patients and ancillary services such as paramedics? Again, it helps to delineate the scope of the subject.
The discussants’ successes are tangible and their aspirations are laudable. Their organizations are headed in the right direction but are constrained by what existing computer technology has to offer. They are utilizing what they have to the max but will not be able to do things that are qualitatively different until it becomes possible to build computer systems that are qualitatively different from those we now have.
I believe that the future potential of computing to influence the way we practice medicine is much greater that these discussants suggest. If the technological advances that I envision come to pass, the glass of the future will much larger than today's glass.
With that in mind, today's glass seems too small and if its contents were transferred to the new, larger one… well, you get the idea. When I imagine the possibility of a larger glass, today's glass seems half-empty. Does that make me a pessimist or an optimist?
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