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Using decision management for meaningful EMR


I saw this comment last week in The US stimulus program Taking medical records online – McKinsey Quarterly – Health Care – Strategy & Analysis and it struck a chord with me:

health care providers to upgrade their IT systems rapidly to reach the act’s standards for “meaningful use” of EMR (Electronic Medical Record)

This phrase – meaningful use – strikes me as particular interesting. If I put all your medical data into a format where it can be shared and integrated and make all that information available to those who are providing care is this a meaningful use? Well, no, not unless they change their behavior based on that data. We should not build EMR systems just to integrate the data or improve its quality or to make it more readily available. We should build EMR systems to improve healthcare delivery. Only an EMR that improves healthcare delivery, that results in medical decisions that are better than those that would have been made without it is valuable and so the only meaningful use of an EMR is to make better medical decisions.

But this requires more than records integration, more than data cleansing and sharing, more than interface standards. It requires medical best practices (evidence based medicine as it is called) to be embedded in the EMR and it requires that those treatments that work better for certain kinds of patients be prioritized/suggested so doctors and nurses see what is likely to work for this patient. It requires, in other words, that an EMR system embeda decision making and usea decisioning technology like rules (to capture medical best practices) and analytics (to identify those approaches that work and the segments of the population on which they work).

Having systems participate in medical decisions is hard.

  1. The system cannot see the patient the way the doctor or the nurse can and this means the medical staff must be integrated into the decision making process and the system must act in a way that complements what they are doing.
  2. Many doctors don’t accept or follow the evidence-based guidelines, so there will be a big change management exercise.
  3. Patients will accept a doctor’s recommendation where they might not accept one given by a computer, reinforcing the need for integration.
  4. There is a need for patient customization so that the doctor can use what they know about the patient to help customize decision making to the patient. For instance bodykom provide remote monitoring for heart patients and crucially allow the doctor to specifiy what kinds of heart irregularities are to be expected and which are of concern for a specific patient.

I blogged about this before in Mr Obama, smarten these systems! and wrote an article for Information Management some time back.


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