Written by Omar L. Gallaga

Matt Chambers

It did not take very long for Baylor, Scott & White's Chief Information Officer Matt Chambers to brighten an interview with his optimistic take on the future of health care. But it was at the very end when he truly expressed the depth of that enthusiasm.

"I absolutely love it," he said about his job, which began in 2011 at Scott & White before its merger with Baylor Health Care System two years later. "I love what I'm doing. It's a thrilling time in health care."

The sunshine can be at odds with some of the grumbling in the industry about the slow adoption pace, high costs and interoperability issues we've written about in this series on electronic medical and health records. But as someone on the front lines of where health records are going for the next five years and beyond, Chambers believes the tight-knit community of health IT experts is going to help deliver on some of the long-awaited promises of the technology.

"I'm very, very optimistic around where we're going," Chambers said. "I think there was some disillusionment. But we're just starting to see the benefits of more preventative and care maintenance. The promise is that they'll help us to do more – from sick care to health care."

Chambers also thinks that the future holds a fundamental shift in the way patients access data, rate their experiences and even shop for health care options.

"The payment model is shifting from being paid for what you do to being paid for what you achieve," he said. "EHRs are really the foundational level to have that transactional data. They’re the foundation for capturing that data."

The role of EHRs could greatly expand as more patients access improved health portals, as connected devices such as home monitors stream live data, and as still-emerging technologies, such as virtual reality and blockchain technology, change what our digital records can contain and how they are accessed and secured.

But to get there, health experts say improvements from leading providers in the $28 billion health records industry, such as Cerner Corp. and Epic Health Services, must continue even as those companies watch their back against potentially disruptive startups.

The Role of Government

One of the driving factors in getting the move to digital records going was the 2009 American Reinvestment and Recovery Act, which created the oft-dreaded "meaningful use" standard for health care records. With a vastly different political landscape going into 2018, there's some anticipation that change may be coming in Medicaid incentive standards, even if it's unclear in what direction.

Nora Belcher

Nora Belcher, Executive Director of the Texas e-Health Alliance, said one of the most interesting recent developments in EHRs has been a Centers for Medicare & Medicaid Services initiative to travel the country and gauge what impact regulations are having on physicians.

The so-called "Patient over Paperwork" initiative will try to determine whether the requirements are too stringent and whether new payment models might lead to cost cuts and better care.

"I think this is potentially a big deal because one of the things I hear over and over from providers is they say ‘my life is worse, not better (with EHRs),’" Belcher said. "In wanting to measure return on investment with all these dollars we spend, we drown our providers in paperwork. Something that could be positive out of this administration is if they're successful in providing some relief to hospitals and providers in paperwork. If they commit to this initiative, I think the technology has the ability to actually bring a benefit."

One of the chief complaints about EHRs over the years has been that they turn medical staff into data-entry workers and that user interfaces are clunky due to some of these incentive requirements, which are expected to be in play until at least 2021. The requirements have thus far driven design on the software side, and not always for the better.

That appears poised to change, as well. Both Cerner and Epic say they are devoting resources to making their patient portals such as CommonWell more user-friendly, to make their software easier to use and train on for providers and, taking cues from tech-industry leaders, introducing concepts such as "emotional design" into their efforts.

They'll have to. While the top few medical-records companies have a stronghold on the $28 billion market, it's ripe for disruption. In addition to dozens of startups, both Amazon and Apple have made hiring moves that suggest the companies may be moving toward entering the health IT market. This would line up with expectations that Amazon will enter the prescription mailing business and that it could tie together its businesses with the rich data it collects from customers, including voice data from its popular Amazon Echo devices, which already have a foothold in American homes.

It wouldn't surprise Chambers. "Patients are expecting us to be convenient. I constantly hold Amazon up as an example. I'm an Amazon Prime member. I don't see us competing against health care (companies), I see us competing against people like that," he said. "Providers will absolutely be disrupted by companies that are more agile."

Travis Good, M.D., co-founder of Datica.com, a company focused on helping hospitals transition to more efficient and engaging health care technology application, says EHRs may already have peaked. EHRs over time will be eroded like Oracle, Siebel and SP were by Salesforce, Workday and Slack. According to Good, "This is a 10- to 15-year process that is only now just beginning but will eventually usher in a new guard of enterprise health IT as it moves into the health care cloud." Good writes that as EHRs move into the cloud and away from on-promise systems, new players could overtake the market.

Right now, Chambers said, patients typically want to be able to message their doctor online, to have access to their medical records and to schedule appointments at their convenience. But things are going to get more complex as patients demand more from their portals and health apps.

Belcher said she anticipates the Yelp effect will take hold: patients will increasingly review health care the way they do restaurants and won't put up with delayed records or badly designed websites.

"Customers have not been demanding this yet, so the systems haven't had incentive to change," Belcher said. "We haven't been hit with the consumer internet model for consumption yet. But we will. The doctors who refuse to modernize their practices are going find themselves further behind."

She said, "Even at hospitals, patients are going to see if it's easy to get a copy of their medical records. If not, they're going to post about it on Yelp."

Virtual Reality, Remote Health and the Future

Even without a crystal ball, it's still not hard to figure out that the nature of what EHRs are is going to change, and unless things go very wrong, the way data is collected and used is likely to improve.

Some technologies that seemed like fringe tech just a few years ago now are poised to be incorporated into the overall EHR picture. Virtual reality, popular for video games and short videos, has the potential to give patients a clearer idea of how health procedures work and to offer a more immersive look at their own medical history. At a September demonstration in Austin, investor and celebrity physician Mehmet Oz, M.D., showed off "YOU," a piece of software from Sharecare, a company founded by the former CEO and founder of WebMD, Jeff Arnold.

Though it used a clunky headset, the software offered a detailed, virtual view of treatments for breast cancer and heart disease. It's not hard to imagine a virtual doctor visit becoming an integral component of a patient's medical history.

Similarly, the same blockchain technology behind the Bitcoin currency could deliver on the idea of decentralized, secure databases that are easier to access, building on the kinds of more open data transfers that the industry has struggled with.

In a list of six predictions going all the way to 2030, Washington University School of Medicine in St. Louis suggests future EHR technology will offer a more detailed map of a patient's health with in-depth content, a better flow of data, and more precise information that can make prescribing medicine more effective. The predictions also include a hope for beneficial partnerships between software companies, educational intuitions and the medical industry, more options for remote medical care and increased patient engagement.

The last two predictions have the potential for the greatest impact, particularly as care needs for the Boomer generation continue to increase. Both Chambers and Belcher said they believe monitored home care will be a game-changer that saves money and allows seniors to live in their homes longer.

"With ubiquitous internet access and cloud access, you could be communicating in real time, and synchronizing data," Chambers said.

Belcher believes the cost benefits will drive that change. "You're talking about maybe $1,600 a year for home monitoring versus $77,000 for a nursing home. You'd keep patients engaged and active and you'd see cost savings," she said.

If the health IT industry can keep its networks safe from hackers and continue to improve its systems while improving user interfaces, there is potential to empower patients with better information about their own health even as their doctors are better able to harness some of the same data to make better diagnostic decisions.

Past, Present and future of EHRs

In our series on EHRs, THA has covered where the health IT business has been, where it is now, and where it's going in transitioning to digital records and holistic health data. Here's some of what we found:

The Past

The $28 billion health records market, which consists of of around 1,000 vendors, got a big boost about 10 years ago when efforts to digitize and maintain electronic records began to go mainstream.

But along the way, interoperability problems, confusion about government-mandated standards for "meaningful use" and slow adoption made the road bumpy. Some medical groups balked at costs, badly designed software and the learning curve for training.

While the bulk of the industry began to go digital, some holdouts decided the trouble and cost weren't worth it, particularly in areas of medicine where there weren't good enough tailored solutions.

Some industry leaders began to emerge and standardize digital records, but it took longer and was more expensive than many expected.

The Present

"A work in progress" is how many in the industry now describe the digital transition as user interfaces improve, but some providers still complain about the workload of data entry and continued issues with interoperability with EHRs.

Some hospitals have begun to harness the data possibilities of electronic systems, using the technology to trim costs and have a better sense of patient needs.

Those who were early to transition and devoted enough staff and expertise have benefited, while many others are still waiting to see the promise of EHRs blossom.

Meanwhile, security concerns have intensified as other major businesses in other industries find themselves the target of hackers.

The Future

Technologies that still seem futuristic such as virtual reality and blockchain transfers could have a significant impact on health IT sooner rather than later. Ripple effects from technology that has yet to reach its full potential could affect EHRs, putting them at risk of obsolesce if that next big thing disrupts the market.

Companies including Apple and Amazon appear to be circling the market while established EHR vendors continue to try to improve their interfaces and empower patients with better, more useful data about their health.

Home monitoring and new consumer-friendly payment models could also upend how health and medical records collect and use data.