Dr. Robert Walker, director of health innovation for the U.S. Army Surgeon General, has been more a frustrated data entry clerk in recent years than a physician, a frustration shared by thousands of his colleagues.
Instead of freeing him for more face-time with patients, the electronic health record (EHR) system he uses has become a third person in the exam room, drawing his attention away from patients. The issue isn't the EHR Walker uses, however; it's the shortcomings of technology in general.
"The electronic medical record has become an impediment versus something that was going to streamline your day," Walker explained in a recent interview. "It took the focus away from the patient and put it all on the computer. People are clicking boxes and turning their backs to patients. It's all about jamming data into this thing."
EHRs makes it possible for every medical care facility to electronically capture a patient's family history, illnesses, treatments and current lifestyle. The promise of EHRs was that they would save the U.S. healthcare system up to $81 billion a year by streamlining workflows and creating massive clinical data warehouses that could be mined for information that could improve preventative care and disease treatment.
That has not yet happened, and doctors are less enamored with EHRs as a result. Last month, the American College of Physicians and AmericanEHR Partners released a survey of 4,279 physicians that showed fully 39% of them would not recommend their EHR to a colleague. That's up from 24% who felt that way in 2010. And 34% said they are "very dissatisfied" with the ability of EHRs to decrease workload.
Under the auspices of the Health Information Technology for Economic and Clinical Health Act, (HITECH Act), the U.S. government is requiring healthcare providers -- hospitals, clinics and private practices alike -- to implement EHRs. Providers must also prove their meaningful use of those systems through a three-stage government process that is taking place over the next four years.
Despite what has so far been an uneven rollout of EHRs in the U.S., Walker and others are already, in effect, building what a treasure trove of patient information that can be tapped to improve patient care, a repository that will revolutionize medicine for decades to come. That is, if everyone can figure out how to categorize it, sort it and access it easily.
Big data analytics engines such as Hadoop have the capability to mine the clinical data warehouses created by EHRs, warehouses filled with valuable unstructured data that can be used to help doctors make decisions about patient treatment.
Today, physicians and pharmaceutical companies still rely largely on text books and infinitesimally small clinical studies that typically use healthy patients with only one disease. That pool of subjects hardly mimics most real-world patients, many of whom have more than one health problem.
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