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Can electronic health records save your world?

-December 06, 2012

EHR (electronic health records) received $20 billion from the American Recovery and Reinvestment Act. Thousands of hospitals and hundreds of thousands of doctors have lined up at the trough. EHR is touted as a way to improve diagnostics, treatment, and to reduce costs.

Are you buying it?
On her blog, Dr. Toni Brayer said, “The advantages are numerous …. Having access to instant, legible information all in one place, shared by all of the caregivers is huge. When I am on call at night or weekends I can see my patient's information and it will prevent medical errors. The EHR can be programmed to give alerts for drug reactions, needed screening tests and medical information.” 

She hasn't even scratched the surface.

You might see EHR as yet another invasion of your privacy and/or a massive waste of $20 billion coupled with government intrusion into your healthcare. The former is probably true, but the latter is short-sighted.

The Los Angeles Times estimated that 150 people, including doctors, nurses, accounting clerks, insurance employees can access a patient's records. With all that data stored in the cloud, count hackers in too. And don't forget that hospitals have made miserable IT a tradition.

There are plenty of reasons for the providers to complain. The federal program is voluntary, but doctors who don't participate will suffer a lower Medicare reimbursement rate. Meanwhile, the cost of digitizing records, training hundreds of thousands of doctors, nurses, care providers, and administrators won't be recovered by increased revenue. Since EHR will reduce the number of tests required to accurately diagnose and treat patients, EHR will reduce medical income (which is kind of its purpose).

Are you ready for the good news?
What if your doctor could compare you, your symptoms, and your situation to a billion other people?

The incredible advantage of EHR is in correlating treatments across large groups of patients. Every treatment of every patient, whether for a hangnail or a tumor, becomes part of a test group. Instead of a doctor looking at a specific treatment that was successful in, say, 80% of trials – trials that include a few dozen men and women, people of random genetic makeup, and ages – a sample of hundreds of millions, eventually billions, can be mined to find people just like you who have already been treated.
 
Here's how it will eventually work:
Patient A comes in with illness B. A's medical history along with vital stats and, coming soon, genetic makeup, are compared to the entire population. That population is reduced to people of similar age, condition, and genetics who have already been treated for illness B. The probability of success is calculated from existing data and, more than that, the uncertainty in that probability is also calculated.

The result is that A and her doctor can make an evidence-based decision. Not a decision based on marginal statistics and random treatments performed in studies on people who have little in common with A, but a decent sample of genuinely similar cases. The ability to pinpoint treatment will reduce the shotgun approach to testing and diagnosing to one or two well aimed treatments.

Data mining is powerful stuff. It’s like how Netflix predicts what movies you’ll like, but instead of movies, EHR can enable prediction of what your welfare would like. Or, if you prefer, it's like having Nate Silver determine the most effective way to run your healthcare campaign.

Pick your own simile, no matter how you add it up, if you’re of the species Homo sapiens, EHR will be good for what ails you.

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