What Will EHRs Look Like in Five Years?

Will EHR usability ever get better? Physicians Practice asked two leading physician experts to look into the future.

The experts are Robert Wachter, physician, professor, and interim chairman of the Department of Medicine at the University of California, San Francisco (UCSF), as well as the author of "The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age," and John Halamka, professor of medicine at Harvard Medical School and chief information officer of Beth Israel Deaconess Medical Center in Boston. Along with those credentials, both Halamka and Wachter were recently called upon by Jeremy Hunt, Secretary of State for Health in the United Kingdom to review problems with the country's health IT systems.

In other words, these are doctors with their fingers on the pulse of digital healthcare. Where do they see EHR usability in five years? Here's what they said:

Halamka: I am very optimistic about EHR usability and here's why. The [major EHR vendors] are fine, but do you believe the best innovation within the EHR space will happen with those vendors or will it happen in the garages of 26-year-olds who are working for free for equity? It's probably the latter … This year, you've seen every [health IT] vendor open up their EHRs to third parties, so the hot ticket at the[\,Healthcare Information and Management Systems Society] conference five years from now will be app stores all over … There will be an ecosystem of apps [connected to EHRs].

At Beth Israel Deaconess … we have all these young doctors who happen to be practicing, but they also write apps. Think about the people who graduate from medical school today, they are all digital natives. They grew up with their smartphones. Who is most likely to know what workflow innovation will really help? How about a doctor who writes code? That's where you'll see these smartphone apps come from … from doctors, nurses, pharmacists, social workers who are creating apps to make their own lives simpler.

Wachter: In my book, I talk about the productivity paradox. It's the experience of almost any industry. They implement IT with grand hopes, several years go by and not much good happens and people are left scratching their heads. Then, usually in about year 10, it starts getting better, both because the systems get better and because people begin rethinking the work in fundamental ways. The uptick in EHR installations really began in 2010 through the distribution of [the Health Information Technology for Economic and Clinical Health Act] money and was completed last year with an adoption rate of 80 percent to 90 percent. In that sense, we are really in year three to five in our journey.

That means we should have five years to figure it out. I think healthcare is more complicated than other industries, therefore we are 10 years away. Ten years from now, we'll see fundamental shifts. In five years, the pressure coming from value-based payments and from clinician burnout are such that there will be a lot more work put into the interface between the clinicians and EHRs. There will be moderate improvements … Five years is a little short to have a truly optimistic view … but I think five years will be better than it is now. It has to be.