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The need for automated decisioning in healthcare

(Posted by guest blogger, James Taylor)

Regular readers of the blog will know that I am fairly cynical about the power of electronic health records to be more than a building block for better healthcare. I do not believe that we will all get significantly better care simply because our doctors have access to an electronic record. So, for instance, when I saw this article A New Push for E-Health Records over on CRM daily I was disappointed once again. While the article discusses the importance of giving doctors an incentive to move to electronic records, it does not address the fundamental issue that an electronic record is only the beginning. Yes, as the doctor in the article notes, an electronic system allows them to treat patients even when not next to the paper files and that's a useful bonus. However, given the very real time and cost pressures on doctors, it is not obvious how much more value they might get out of it.

Let's face it, how long does your doctor spend with you? How much time do they have to review your records (electronic or paper)? The answer for most of us, especially those who need better and cheaper healthcare the most, is not much. Having more data at their fingertips will work as well for doctors as it did for other professionals. Remember the old saying "drowning in data but starved of information"? The danger with a focus on electronic health records is that we will do the same to doctors we once did to managers - overwhelm them with data without really helping. Don't get me wrong, we need electronic health records as part of a push to improve the costs and accuracy of healthcare delivery but they are just the foundation. To be useful we need healthcare systems smart enough to really help doctors. Such systems would, for instance:

  • Respond to the posting of an event like a test result by applying rules and analytics to see if the test result represented either a risk factor or a significant change for the patient
  • Allow doctors to use standard thresholds and rules or customize them for a particular patient ("I know this patient has high cholesterol so don't report it to me unless....")
  • Respond to the particular reason given by a patient for a visit with an analysis of the symptoms they report and their prior history, making suggestions for additional tests or potential diagnoses
  • Given the data in the record, prompt patients and doctors to have patients come in for tests or checkups when that is necessary
  • Check all prescriptions for drug interactions, check dosage rules given the patient's weight/size etc
  • Use location data and travel plans to derive additional checks or things to watch for based on geographic disease information (now widely available)
  • and so on

Hopefully you get the picture. An electronic health record is necessary, for sure, but it is not sufficient. We must be thinking in terms of a new class of system to support doctors and patients in delivering better (and cheaper) healthcare.

Other posts you might enjoy on this topic:


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You are correct: electronic records seem to improve quality of health care.

I would not overemphasise though: they are not pancea. The system has to be designed well and it has to do it correctly.

Also, if a system is designed to treat - it will not do prevention automatically...

Some examples of "modern" thinking in this area (Google vs. Microsoft):

The systems as they are planned are ok. But, in my opinion, they are still disease, not health, oriented...

Best of all to you.


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