In recent months, the concept of the electronic health record has come to the forefront of the national debate on healthcare. Thanks to government incentives for physicians who adopt this emerging technology, acronyms like EHR, EMR, and PHR have become household terms. The mainstream use and acceptance of EHR will not only help patients connect to their health more intimately, but it will also help eliminate inefficiencies and reduce costs throughout the entire healthcare industry, but only if they are done right.
Where can we turn for some good advice on how to properly implement EHR? How about one of the most advanced civilizations ever to grace the silver screen?
On the U.S.S. Enterprise, the future of healthcare is revealed. I’m not talking about the futuristic capabilities of their medical technology, but rather the basic logistics of a medical practice aboard a Starfleet vessel. That’s because if anyone can get EHR right, it’s Starfleet. Their LCARS system includes a fully integrated practice management system, complete with patient health records, an efficient workflow engine, and on-demand telemedicine capabilities.
The way the writers portray it, Starfleet seems to have it all figured out, so let’s take a look at some of the ideas they tossed around for how physicians practice in the future:
1. Multiple Channels for Data Entry
Physicians shouldn’t be limited to just keyboard and mouse, or just gesture controls, or just anything. An effective EHR solution should accept many different forms of data entry, not the least of which is voice recognition. The concept of voice recognition is so obvious as to be implied, and the idea has been around in science fiction since the earliest mentions of a computer. Aside from jetpacks, the lack of effective voice recognition technology in 2010 is the single biggest letdown of our technological prowess, but progress is being made. Doctors need the ability to use voice commands to access files quickly while simultaneously performing other tasks, but this isn’t the only desired channel for data entry. A well-rounded mix of different input methods would go a long way towards adding versatility and usability to EHR systems.
2. Interactive Patient Education
After diagnosing a patient, the physician enters the appropriate codes into the system and the diagnosis is immediately recorded in the PHR. But what does any of it mean to the patient? The EMR system should have the option to immediately display information about the diagnosis for patient education. So if the patient has chickenpox, for example, after entering the diagnosis, the doctor can tap an icon on her iPad and bring up some basic information on the varicella-zoster virus. This would help boost patient compliance by helping them visualize their illness, i.e. by seeing an image of the virus or bacteria they are infected with.
3. Holographic Doctors
There is projected (pun intended) to be a huge shortage of physicians in the near future. If we don’t do something soon, the quality of care will diminish and costs will soar. OK, the solution doesn’t need to be (and isn’t very likely to be) holographic doctors. We can either find a way to clone some doctors, train some robots as nurse practitioners, or leverage the technology we have to make our existing doctors more efficient. We’re talking about telemedicine here. We need to free our physicians from the shackles of the physical. We need to make ‘point of care’ mean ‘everywhere’ and ‘patient visit’ means ‘secure high-quality video chat.’ This will cut down on needless visits, waiting room lines, and involve patients in their health more genuinely.
4. Detailed PHR on Demand
Instant access to a patient’s entire medical history: the ultimate EMR. No fumbling, no fussing around, no clicking, no right-clicking, no backtracking, no waiting, no missing files – just quick and painless access to a patient’s health record for any physician at any point of care, from the family practice to the emergency room. Unlike the (presumably) closed Starfleet healthcare ecosystem, however, data security is of vital importance in the real world. There are very real dangers when transmitting sensitive data over the Internet, but once security concerns are addressed and patient privacy can be guaranteed, the safe transfer of EMR between providers will proliferate and patients will be better off for it.
5. Integration with Vital Signs Monitoring Systems
Real-time logs of patient vital signs which are automatically monitored and recorded into patient health records, even remotely via wireless monitoring devices. These exist today, and will likely become commonplace in the future – wearable devices that communicate directly with the system sans-cable, some of which will be implants that may never need to be removed. The data is transmitted directly into the patient’s health record, which they can monitor via the patient portal and on their mobile device. This kind of integration would require that EMR systems adopt open APIs to allow for communication with 3rd party devices and systems.
6. Adaptive, Intuitive Touch Screen Interfaces
Though the graphical user interface on Starfleet computers is highly stylized, the show’s artists clearly had usability in mind when they designed the look and feel of the system. Notice how the intuitive, color-coded, gesture-based interface changes to display only the options and information needed at that point in the workflow. The iPad promises to deliver on this once-impossible feature, and its rapid adoption by physicians is proof that multitouch input is a much-needed feature in electronic health records systems.
7. Real time Practice-wide Synchronization
The Enterprise sickbay is designed in a way that has different components of the workflow residing on separate devices spread throughout the room, presumably designed for maximum efficiency. Effective EMR solutions need to function in real-time, transmitting information between every device on the network to keep each one up to date at all times. These days, the cloud is the most reliable and efficient way to synchronize information in real-time, regardless of the current location. The technology should enable a more manageable workflow for physicians and staff, who need access to the same information in real-time for different purposes, such as clinical note-taking and creating billing encounters.
8. Remote Access for Patients
Patients need to be able to access and interact with their personal health records from home, whether to sit and discuss treatment options with family or communicate with their family pediatrician regarding a newborn’s medication. This means they need a true patient portal, not just some download link to an unintelligible file. This data belongs to the patient, not to the practice, and so should be easily accessible and highly mobile. Patients should be able to pore over their personal health records from the comfort of their own quarters or via a mobile application on their smartphone. With effective EMR systems in place, the patient’s health belongs to the patient.
9. Support for Mobile Devices
Tricorders may not seem as advanced as the smartphones on the market today, but their greatest strength is in their direct integration with the central computer system. While an iPhone may not be able to detect life signs or take an EKG reading, it can be used by physicians to stay connected and informed at all times, and there’s no reason an iPad can’t communicate with the existing monitoring system. (See #5). For patients, mobile applications can be used for appointment confirmations, driving directions, and even timely medication reminders.
What science fiction imagines, scientists strive to create. Science fiction is rooted in science, and science fictions writers portray the future in terms of at least some feasibility, meaning their ideas are often based on sound science, whether or not the technical applications for this science currently exist. They sit and ponder, how would a medical practice look hundreds of years in the future, and why? Their ideas are not just whimsical fantasy, but the product of logical thinking and some healthy optimism.