A presentation I made at the ITCH conference in Victoria in 2017 as a member of a panel of experts on EMRs and EHRs.

1. Karim
Keshavjee,
MSc,
MD,
MBA,
CCFP,
CPHIMS-­‐CA
ITCH
2017
Feb
19,
2017
Victoria,
BC

2. ¡ EHRs
have
pretty
much
failed
all
over
the
world
(I’m
talking
about
centralized
medical
records,
not
American
physician
medical
records)
¡ Why?
¡ There
are
a
thousand
reasons,
but
the
#1
reason
Our
collective
hypotheses
about
EHRs
are
incorrect

3. Doctors
need
data
to
look
after
patients
(duh!)
If
we
give
data
to
them
faster,
patients
will
get
better
faster
(The
“Replace
Postal
Service”
Hypothesis
of
Better
Care)
Let’s
also
make
it
Machine
Readable
so
Computers
can
double-­‐guess
the
doctors!

4. ¡ It
may
be
true
(unproven)
¡ But
solving
this
problem
has
NOT
created
enough
value
to
justify
the
costs
¡ The
experiences
of
the
Health
Information
Exchanges
(HIEs)
in
the
US
bears
this
out
§ HIEs
are
purer
versions
of
the
“Replace
Postal
Service”
with
a
lower
cost
structure
than
EHRs
§ They
have
also
failed
¡ HL7
and
Interoperability
are
also
massive
failures
–they
are
also
based
on
the
RPS
hypothesis

5. ¡ We
should
be
identifying
and
testing
multiple
hypotheses
as
we
move
forward
¡ But
how
will
we
know
which
one
is
the
right
one?
¡ Easy!
¡ Humans
and
systems
are
good
at
identifying
value
and
embrace
it
quickly
§ Christoph
Lehmann
pointed
this
out
nicely
in
his
Keynote:
When
IT
goes
‘Viral’,
you
know
you’re
onto
something
¡ What
we
need
to
do
is
try
out
a
bunch
of
alternative
ideas
and
see
what
works
§ But….where
should
we
look
for
better
ideas?

6. Research
Study
Research
Study
Synthesis
Researchers
Academics
Clinician-­‐Scientists
Clinicians
Patients
Guidelines
The
Healthcare
Value
Chain

7. ¡ The
steps
along
the
way
by
which
we
add
value
to
raw
materials
¡ In
the
Automotive
Industry,
they
take
iron
from
holes
in
the
ground
and
make
nice
shiny
cars
which
you
can
buy
from
your
local
neighborhood
dealer
§ They
don’t
make
you
go
to
Northern
Ontario
to
dig
up
the
iron
and
smelt
it
yourself
¡ In
healthcare,
we
discover
new
facts
and
treatments
that
we
can
deliver
to
patients

8. ¡ There
are
many
stakeholders
in
the
healthcare
system
who
ADD
value
to
the
system
¡ When
they’re
left
out
of
the
IT
equation,
real
value
cannot
be
created

9. Stakeholders
Researchers
&
Academics
Providers
Patients
Ministries
of
Health
Systems
Implementers
Guideline
Implementers
Vendors

10. ¡ Lowering
the
costs
of
providing
healthcare
through:
¡ Predictive
analytics
–to
provide
care
that
matters
to
patients
and
to
allocate
resources
better
§ Everyone
agrees
there’s
lots
of
waste
in
the
system,
but
nobody
knows
where
it
is!
§ Will
need
researchers
and
data
scientists
to
identify
waste
§ More
than
anything,
we
need
better
measurements
of
“What
is”
§ That’s
what
impressed
me
most
about
Christoph
Lehmann’s
presentation
–not
his
great
inventions,
but
the
fact
that
he
had
such
great
granular
data
¡ Shared
data
for
coordinated
care
§ Virtualization
of
care
beyond
bricks
and
mortar

11. ¡ Increased
patient
empowerment,
access
and
control
(mobile
apps,
block
chain)
¡ Chronic
disease
logistics
(lots
of
patients
falling
through
the
cracks)
¡ Ability
to
rapidly
test
hypotheses
§ Big
data
is
meaningless
without
hypothesis
testing
¡ Ability
to
share
innovations
using
non-­‐
commercial
dissemination
mechanisms