Some perspectives on “Escaping the EHR Trap – The Future of Health IT”

Bill Crounse 2007 05If I was going to write a testimonial to my company’s value proposition in the health industry, I couldn’t have said it better than the authors of an op-ed piece in yesterday’s New England Journal of Medicine.  In the article, Escaping the EHR Trap – The Future of Health IT, Drs. Kenneth Mandl and Isaac Kohane provide a realistic assessment of currently available electronic health record solutions and why so many clinicians are far from satisfied with what they’ve been getting from the tech industry to date.  The following paragraph does a good job getting to the heart of the matter.

imageEven as consumer IT — word-processing programs, search engines, social networks, e-mail systems, mobile phones and apps, music players, gaming platforms — has become deeply integrated into the fabric of modern life, physicians find themselves locked into pre–Internet-era electronic health records (EHRs) that aspire to provide complete and specialized environments for diverse tasks. The federal push for health IT, spearheaded by the Office of the National Coordinator for Health Information Technology (ONC), establishes an information backbone for accountable care, patient safety, and health care reform. But we now need to take the next step: fitting EHRs into a dynamic, state-of-the-art, rapidly evolving information infrastructure — rather than jamming all health care processes and workflows into constrained EHR operating environments.

IMG_4711Over many years of traveling the world and writing this blog I have frequently commented on EHR and HIS (hospital information system) solutions that I’ve had an opportunity to observe overseas.  In some cases, clinics and hospitals have built their own EHR/HIS solutions using widely available and well proven, commodity technologies, development tools and software from Microsoft and other market leading companies.  In many cases, these solutions are built for pennies on the dollar compared to the costs associated with purchasing and implementing EHR/HIS systems in America.  Instead of a primary focus on documentation and putting massive amounts of data into neat little boxes, these home-grown solutions tend to place more emphasis on using technology to facilitate better communication and collaboration in clinical workflow.  Instead of turning busy clinicians into data entry scribes there’s more of an effort to turn what data exists in the electronic record into something that is meaningful and useful to clinicians in the care of their patients.  While I would not claim that these simple solutions are perfect or even comparable to the mega-installations we see in America, they seem to work perfectly fine where they are being used which is often in countries that don’t have a lot of cash to spend.  I would also say that the clinicians I’ve observed using these systems seem to be a whole lot more satisfied than clinicians I talk to in America.

Toward the end of the NEJM article Mandl and Kohane hold out some hope for the future.

The IT foundation required for health care is the core set of health data types, the formalization of health care workflows, and encoded knowledge (e.g., practice guidelines, decision-support tools, and care plans). With those ingredients, existing free and flexible software can support the automation of biomedical processes. Many businesses have adopted large-scale, transindustry platforms to support customer relations, Web applications, and secure cloud-based data storage. Health care is ripe for this approach.

imageSometimes good things happen when people are forced to be frugal. The best solutions are frequently not the most costly.  That is certainly true when we anticipate a future of computing that is done more in the cloud than on premises.  Many hospitals and clinics are already discovering how to save a lot of money by moving their commodity workflows like messaging, e-mail, documentation, collaboration, communication, and customer service, to the cloud.  Even more of our customers are learning how to optimize their existing EHR/HIS systems with  commodity communication, collaboration, and health information modernization solutions from Microsoft.  You can learn more by visiting

Bill Crounse, MD                       Senior Director, Worldwide Health                      Microsoft


Comments (1)

  1. George K Fahnbulleh says:

    Bill, this is an excellent article, I tried to address some of it in my blogpost in 2010

    Keep the hits coming!

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