A Prescription for the Achilles Heel of Healthcare IT


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help enable high-quality, personalized, coordinated, and cost-effective healthcare to all Americans. Realizing this potential just requires a little teamwork.

Too often, the reality is that poorly designed and implemented EHRs can add as many problems as they solve. A comparison with the highly efficient computer information systems available in other time-sensitive, mission-critical settings, such as finance, aviation, power-plant control desks, and military combat platforms, reveals the striking limitations of EHRs and their underutilized potential. This is despite the importance of our healthcare industry, which accounts for 18 percent of the U.S.’s gross domestic product—and is growing.

Looking at the complex, comprehensive, real-time financial data presented by a current Bloomberg terminal, I can’t help but imagine how effective and essential a similar system could be for healthcare.

Physicians would instantly be able to see both real-time and historical patient data according to their needs. Imagine being able to view a diabetic’s blood pressure and glucose, tracked over time, in conjunction with diet and exercise logs, medication adherence statistics and lab work— all data currently scattered throughout the EHR.

Taking it a step further, what insights could be gained by securely comparing patient outcomes across a large population, the way traders compare stocks? With one click, I could compare one patient’s data with all other patients in my practice who have diabetes, or perhaps plot the potential for progression to kidney failure for my patient, based on newly published data from a large research study, to better predict my patient’s outcomes. Imagine this potential to help manage and care for a large population of patients.

Bringing in relevant data from a variety of electronic sources is the heart of the Bloomberg terminal—and the Achilles heel of healthcare. Unlike the Bloomberg terminal, which can easily cross reference inflation from the Euro to the Yen, healthcare technologies such as EHRs and medical devices don’t speak a common language and thus can’t communicate directly, due to a combination of business and technical decisions. Solving interoperability of healthcare data is one of the keys to making EHRs more effective, cutting costs in healthcare and reducing the medical errors estimated to cause more than 400,000 deaths per year.

Of course I’m not the only physician who can imagine how to make EHRs better – this week, the American Medical Association released an action plan with eight key ways EHRs can be improved to be more user-friendly, advancing the patient experience, the health of populations and helping lower the cost of healthcare.

Instead of forcing overworked physicians to multitask between patients’ needs and clinical decision making, while also navigating a burdensome EHR system, wouldn’t it be ideal if EHRs incorporated these changes? Instead of keeping doctors up at night, they could allow better patient engagement and smarter decision support while also providing an efficient workflow that allowed clinicians to devote undivided attention to every patient.

It’s enough to make a sleep-deprived doctor dream.

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Zia Agha is executive vice president of clinical research and medical informatics at the Gary and Mary West Health Institute, an independent nonprofit medical research organization focused on reducing healthcare costs. Before joining the institute, Agha was director for health services R&D at the VA San Diego Healthcare System and a professor of medicine at UC San Diego, where he is still a part-time faculty member and practicing physician. Follow @

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One response to “A Prescription for the Achilles Heel of Healthcare IT”

  1. ReasObBob says:

    Good overview of the EHR symptom issue.

    I say symptom, because the IT application known as an EHR system isn’t the problem. The problem is explained by path dependence. Simply put, the EHR system as we know it is the wrong tool for the job. But, it happened. That doesn’t mean we have to live with it forever.

    Instead of EHR systems, what is required is point of care systems that accommodate and integrate all six flows that converge and intersect at the point of care. This inability to accommodate all six flows — which were recently identified as a result of our research — is the real Achilles Heel of the current generation of health IT systems.

    What is needed is a new path, using contemporary IT and networking design leading practices, that will enable us to specify and build the next generation of health IT systems and the rock solid communications infrastructure they will require. Unless — and until — we do that, we have no real chance to achieve the Triple Aim.

    For more insight into a non-commercial, community-based, movement to develop the kind of health IT systems we truly need, I hope you’ll visit http://www.TheCUREProject.org. Check out the Current Research section for more information.

    – Bob Brown