How do we even begin to address health care woes? John Healy proposes we start all the way at the beginning: how do we fill out paperwork, and how does that automatically make everything just a bit more manageable?
If there is one part of society that is woefully behind the times top to bottom, it’s healthcare. Despite incredible progress in basic research over the past 50 years, from recombinant DNA in the 70′s through to the human genome project, we still take crude drugs for many conditions and there are precious few cures. Pricing for hospital services is widely divergent based on insurance, which creates conflicts of interest between providing the highest quality of care and maximizing the bill you go home with. Even getting a diagnosis remains difficult and wasteful, primarily due to a lack of communication between doctors, technological aides, and entrenched financial interests.
Some of these issues can be excused. For example: basic research does not always lead to treatment, as biological systems are usually more complicated than they may at first seem. The FDA has not created protocols for many new potential drug classes, forcing these drugs into a high-risk, high-priced, and time-consuming review process that stifles innovation. Many hospitals struggle financially even after exploiting Medicare and insurance to the fullest, and changes to the incentive system had been slow in coming (although many are going into effect in the next few years due to Obamacare).
But one area where there is no excuse is communication. There is no good reason for medical records to still be on paper.
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No current standard
There are many attempts out there to create the electronic health record. So far, the most successful has been BlueButton, the government’s standard, currently in use primarily by the Dept. of Veteran Affairs (VA). While basic, the system works: a doctor in any VA hospital can pull up a veteran’s history online (as can the veteran themselves). Another system, EPIC, is in place at many private hospitals, but records are separated by hospital.
If you’re not appalled at this, you should be. Consider being taken to the emergency room, unconscious, with no one to report your previous surgeries, allergies, medicines, or anything else about your medical history. Are you bleeding out and taking bloodthinners? You could be dead.
Indeed, part of the healthcare bill, known as the “meaningful use” doctrine, attempts to correct the record-keeping problem. In order to qualify for full Medicare reimbursements, hospitals will need to meet a number of benchmarks in using electronic health records, including the ability to export the record in a standard format. If hospitals don’t conform, they lose certain reimbursements. It works in a similar way to the national drinking age law; few hospitals would be able to survive the decreased reimbursements.
Having additional data should lead to improved hospital protocols, as well as tools allowing patients to manage their own care. In a healthcare setting, we can expect redundant care to be eliminated: for example, giving a tetanus booster for all ER puncture wounds regardless of immunization history. With current medications and care history available on hand, anywhere, we should also expect fewer drug interactions and better decision-making concerning chemotherapy versus radiation. Incredibly stupid annoyances, like hand-delivering MRI results to your doctor, should finally become a thing of the past, saving time and lives in the process.
To address the patient side, the government recently held a challenge to redesign the presentation of the VA’s BlueButton record system. Symptomatic of the overall plight of electronic medicine, the current BlueButton record is a flat text file. Nearly everything written about the Electronic Health Record (EHR) problem, including this challenge, stresses the idea of “patients first,” and for good reason; if I, as a patient, have a better understanding of my health, I can take better care of myself and don’t need to visit the doctor as often. In the over 200 submissions to this challenge, a wide variety of improvements are explored.
I designed Ehrgonomic to help patients better understand and use their medical records, while also improving the provider experience and minimizing errors. The design applies web usability with print journalism to create a usable, readable, and accessible record. For example, more immediately pertinent information (such as medications and basic care plans) are float to the top. History items, such as immunizations and hospitalizations, are condensed together and easily filterable by type or timeframe, allowing patients and doctors to get an immunization record or a three-year history with a single click. In order to accommodate increasing use of tablets and phones (both by patients and within hospitals), I applied a basic responsive design that collapses basic information and filters into a menubar.
Consistency and familiarity was perhaps the most important principle in our design. I chose to retain the same look and feel for all layouts (desktop, mobile, and print) so that patients would only need to learn a single system. Similarly, we kept all sections of the record, including test results, in a simple table format to minimize the number of moving parts. I considered color in many sections but ultimately decided to use it in only two ways: to differentiate the types of history items, and to indicate areas of emphasis (warnings, severe allergies, and failed test results). In particular, we stayed away from any sort of green-yellow-red treatment of test results to accommodate colorblindness, and we avoided any sort of chart or scale for test results to keep the focus on the binary test result (normal vs. not normal).
Turning the corner
As relieved that I am that medicine is finally becoming electronic (and hopefully gets there before I have a major medical problem), the process to get here has been exasperating and the industry still has a littany of issues. For this reason, it is critically important that patients have as many tools as possible to understand their own health. This allows them to intelligently discuss the pros and cons of treatment options, and to make effective personal health decisions.
John Healy is a contributor to What Are These Ideas. He recently designed Erghonomic alongside Gabriel Diaz. You can see their work at http://www.ehrgonomic.com/This is his first post.