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Future of EHR / EM for NYEMHPA

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by Nicholas Genes on 21 October 2014

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Transcript of Future of EHR / EM for NYEMHPA

EHR
past, present & future
what
the future of EHR
can tell us about
the future of EM
Nicholas Genes, MD, PhD, FACEP
Icahn School of Medicine at Mount Sinai
December 11, 2013
disclosures
EHR
Epic, MU, ICD-10
alert usability
HIE notifications

social media / apps
MedGadget
Medscape
EPMonthly


no financial ties to vendors

case 2

new mother, accidental overdose, insomnia
postpartum depression?
patient reassures you, wants to leave
case 1

older man, recent prostate surgery
wife says "he's not himself"
urine is dirty; antibiotics and discharge?

two truisms on futurism
"the future is already here, it's not just very evenly distributed."
- Gibson

"we always overestimate the change that will occur in the next two years, and underestimate the change that will occur in the next ten."
- Gates
"everything in healthcare takes longer than you could possibly imagine."
- adapted from Strayer
meaningful use
- rewards for EHR? must use EHR for new model of care

promote standards, address issues not already driven by market forces
stage 1
focused on measurements, reporting

spurred
70% EHR adoption
in US hospitals
55% in clinics

usage persists after reporting period passes
what's the benefit of
monitoring social feeds?
workplace wellness programs - legality


as of 2014, 30%-50% of health insurance premium can vary based on a "health factor"

"reasonably designed to improve health or prevent disease" - must provide alternative

HIPAA wellness exception
even if social & device data
feeds into EHR...

how will doctors process it?
Thank you
case 2

resolution

automated reviewed of social feeds (based on CC) note increased signs of depression in comments

psychiatry consulted, postpartum depression identified by EPDS, followup arranged
case 1 resolution

fitness device's accelerometer data revealed fall

head CT reveals slow-growing subdural.
references:
@nickgenes
www.blogborygmi.com

stage 2
builds on stage 1, and calls for

data portability, patient engagement
to qualify for
stage 2:


stage 3
early drafts:

stage 4?
not part of original stimulus bundle

EHR may accepts data feed from pharmacy

notifications of pt movement throughout HIE

consumer device integration?


vendors halve already announced plans
short leap from device stream to social stream
Meaningful Use
is not only game in town
but what will drive patient engagement?
workplace wellness programs - efficacy

studies suggest fewer sick days, lower employer health costs, lower disability

for each $1 on wellness, employer saves $3.27

trials on employees show little lasting benefit (smoking, weight loss)

in summary...
EHR integration with devices, social streams
will be possible, may be incentivized
EM docs used to operate with paucity of info;
will need tools to manage data deluge
vendors, payers, researchers will benefit
patients may benefit, too
as patients
accumulate notes
, meds & problems in EHR

searching & sifting for relevant details more necessary

algorithms
can prioritize / surface potentially relevant data from current & past visits


quantified self literature:
validating device vs. established measures

what would convergence look like?
does this stuff work?
hospitals attest that 10% of transfers / referrals use electronic summary of care record
50% of patients can view & 5% can download, transmit their health information after discharge
case reporting from EHR to public health registries

import decision support rules from central repositories

generate realtime reports of pts with specific diagnoses
ACOs:
population mgmt, care coordination
NIST:
to improve usability for data display, CDS
premise that EHR, lit have too much data, not too little
IBM Watson
filtering, organizing & NLP of freetext chart narratives
designed to assist, identify missing info, not replace
based on chief complaint, vitals, labs, medical precepts
sepsis notifications at Mount Sinai
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