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Future of EHR / EM for NYEMHPA
Nicholas Geneson 21 October 2014
Transcript of Future of EHR / EM for NYEMHPA
past, present & future
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
Epic, MU, ICD-10
social media / apps
no financial ties to vendors
new mother, accidental overdose, insomnia
patient reassures you, wants to leave
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."
"we always overestimate the change that will occur in the next two years, and underestimate the change that will occur in the next ten."
"everything in healthcare takes longer than you could possibly imagine."
- adapted from Strayer
- rewards for EHR? must use EHR for new model of care
promote standards, address issues not already driven by market forces
focused on measurements, reporting
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?
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.
builds on stage 1, and calls for
data portability, patient engagement
to qualify for
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
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)
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
, meds & problems in EHR
searching & sifting for relevant details more necessary
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
population mgmt, care coordination
to improve usability for data display, CDS
premise that EHR, lit have too much data, not too little
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