We need medical decision management not just electronic medical records

An article on electronic medical records in the New York Times caught my eye recently. In this article was the comment:

Computerized patient records are unlikely to cut health care costs and may actually encourage doctors to order expensive tests more often, a study published on Monday concludes.

Now I don’t know specifically what about the specific electronic medical records might have caused this but it illustrates, I think, a general problem with the discussion of electronic medical records (EMRs). In general there is an assumption that simply putting all the relevant data in one system or otherwise resolving data sharing issues will miraculously result in better care and lower costs. Yet most doctors are busy, rushing from one patient to the next with little time to review the (now much longer) patient record of a typical patient. They also insist on remember all the guidelines for tests, all the diagnostics they learned in med school and all the symptoms of everything – when did you last see your Doctor look something up? In this environment, simply presenting more data is hardly likely to help.

What would help is medical decision management – systems that were active participants in healthcare. Systems that applied symptom, diagnostic and other established rules to see if specific tests were likely to be useful or even contra-indicated, systems that trawled through past history to identify those things that might be relevant right now, systems that applied analytics to predict which treatment approach was most likely to work. Such systems do exist and are in limited use in forward looking organizations but they are few and far between. Yet it is only the provision of such active, decision-centric systems that will truly change healthcare. Add in remote monitoring and the coming wave of medical sensor data and the need for these systems will grow – remote monitoring will not work if decisions are only made when someone happens to be available to look at the data after all.

I have blogged before about the importance of active electronic medical records, the stupidity of doctors who insist on trying to remember all the rules, the need to change behavior not simply capture medical data, and generally on the need for smarter systems in our healthcare environment.