Healthcare is Entering a Post-EHR Era

Prof. Robert M. Wachter, MD, Chair of the Department of Medicine at the University of California, San Francisco, USA, and author of The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age was the keynote speaker at the openEHR 2020 Digital Event: DATA FOR LIFE in November 2020.

In his talk titled Entering the Post-EHR Era, he gave his view on the digital revolution in healthcare. Here we would like share the three main messages of his keynote.

First, to point out where we are in the process of healthcare digitalisation, prof. Watcher described the four stages of healthcare IT:

1. Digitising records; converting records from paper to digital.
2. Connecting all the parts of the system:
   • General practitioners to hospitals, hospitals to hospitals, etc.
   • Third-party applications and patient-facing systems to enterprise systems​.
3. Analysis, or gleaning meaningful insights from the data​.
4. Converting these insights into actions that improve value.

Most developed countries have completed the first stage to a high degree, but only a few have made significant progress in the second stage. Even more significant is the fact that very few efforts have been made with stages three and four at a national level. Most other industries (financial services, travel, etc.), which started their digitalisation process two or three decades ago, have already covered all four stages. 

Second, prof. Wachter talked about the productivity paradox, a phenomenon that occurs when productivity slows down despite rapid development in the field of information technology. There are two keys to unlocking the productivity paradox:

1. Improvements in technology
2. Reimagining the work itself

The second is far more important. For instance, the physician’s note in an electronic health record does not need to look like a digitised paper form. In a digital-first era, among other possibilities, it can be richly linked, with audio or video files included, interactive, or even created collaboratively.

Third, prof. Wachter made some predictions:

• Healthcare IT will, ultimately, transform health and healthcare (interoperability will be needed for seamless data flow and plug-&-play​).
• New systems will be less institution-focused, more patient-centric, higher in quality, less expensive, and more equitable​.
• The winners will be any one of these four parties:
  • Existing healthcare organisations that adapt to thoughtfully embrace tech​
  • EHR vendors that innovate and open their architecture​
  • Digital giants that are able to maintain a focus on health​
  • New companies that skilfully address important use cases​ in health and care

However, prof. Wachter also noted that these predictions are easy to make. The hard part is predicting when they will happen.

In the closing thoughts of his keynote, prof. Wachter said, “We are going to be entering a golden era where healthcare is going to be better, safer, less expensive, and more satisfying, ultimately not only for patients, but for clinicians as well. But, that is utterly dependant on getting a whole lot of things right that we have not got right so far, including moving effectively into an era where we take advantage of electronic health records, but are no longer dependent on them, and where we enter a post-EHR era.”