Future Reform Predict the Form and Function Essay

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Future Reform

Predict the form and function of medical health records in 2030 (provide specific example to support your response).

Models for healthcare delivery are changing, the institutions that deliver it are transforming themselves or being transformed by the marketplace and of course information technology is helping to enable that transformation. Medical technology today is transforming the way healthcare is delivered, managed, and assessed, with a continued shift from the old record management to more of a data management system. As more organizations adopt electronic health records, physicians will have greater access to patient information, allowing faster and more accurate diagnoses. Complete patient data will help ensure the best possible care. Patients too will have access to their own information and will have the choice to sharing it with family members securely, over the Internet, to better coordinate care for themselves and their loved ones.

Digital medical records will make it possible to improve quality of patient care in numerous ways in the year 2030. For example, doctors can make better clinical decisions with ready access to full medical histories for their patients -- including new patients, returning patients, or patients who see several different providers. Laboratory tests or x-rays downloaded and stored in the patient's electronic health record will make it easier to track results. Automatic alerts built into the systems will direct attention to possible drug interactions or warning signs of serious health conditions. E-prescribing will let doctors send prescriptions electronically to the pharmacy, so medications can be ready and waiting for the patient (Bluemental, 2010).

Electronic medical records are a trend that started in recent years and will continue as technology progresses in the future. Electronic medical records are expected to eventually replace the current paper-based patient medical record system. For example, According to the CDC, 38% of physicians currently have switched to an electronic medical record system and it is expected that 86% of physicians or more are expected by 2030 (Christ, 2011). Transcription and coding are now constantly being outsourced, home based, or automated "As more organizations adopt electronic health records, physicians will have greater access to patient information, allowing faster and more accurate diagnoses" (Blumenthal, 2010).

Telemedicine utilizes modern technology such as the Internet to connect patients and physicians. Telemedicine allows a physician to interact with a patient online in real-time, cutting back on time and expenses associated with the typical office visit. Telemedicine is a growing trend that will continue to progress as technology increases (Christ, 2011).

Describe the most likely impediments to health care information access in 2030 and make at least two (2) recommendations to avert those impediments that can be implemented now.

I believe the most likely impediments to health care information access in 2030 the limitations of information technology (IT). As health and health care become increasingly information-intensive, the need for effective IT has become more compelling. While the theoretical advantages of IT in health care have been talked about for decades, the puzzling fact remains that actual adoption and successful implementation of comprehensive systems have been quite rare. Underlying all the usual explanations -- cost, complexity, poor user interfaces, and mismatch to the realities of clinical practice, among others has been a long standing neglect of rigorous evaluation.

Accelerated improvements in health care IT require meaningful evaluations. And meaningful evaluations have been infrequent and often flawed -- under-sourced, not performed under real conditions with real patients, focused on physicians to the exclusion of their clinicians, excluding contextual or cultural factors that are critical to work practice, or tacked on as an after-thought rather than made an inherent part of the design process (Shen, 2005).

On a societal level, lack of interoperable databases and fully effective electronic medical records (EMR) which the IBM terms "health information liquidity" will continue to perpetrate inefficiency, restrict access to data by patients, clinicians, and researchers, and hamper public health efforts including bio surveillance, pre-approval drug trials, and the development of evidence-based clinical practice guidelines (Shen, 2005).

In conclusion, the disappointments of IT are real and will only slowly be solved, particularly since sociocultural barriers will remain even as technology logical bottlenecks are cleared away.


Given the current health care climate with increasing demands for health care organizations to manage patients according to established clinical evidence and practice guidelines, health care administrators should incorporate at least some aspects of EBM, including the associated expenses, into their IT strategic plans. If possible, administrators should provide Internet access to health care providers, although this will not always be possible in some rural locations. As with any IT system, the requirements, comfort level and experience level of potential IT users should be assessed prior to designing or implementing an EBM system. Available EBM systems include free-access to electronic database and search engines to subscriptions to specialized EBM services or clinical decision-support systems.

Similarly, it does not appear that wireless and other mobile devices should be implemented for bedside EBM practice alone. However, EBM capabilities should be considered as a part of any broader mobile device implementation initiative. Currently, privacy and security issues are the most significant limitations to broad wireless mobile device implementation.

Discuss the single most significant "health care bake in" you could embed into organizational workflows and the probable impact it could eventually have.

The single most significant "health care bake in" I could embed into an organizational workflow is alerts. Alerts enhance the evidence base for setting priorities in health care, and promote communication between physicians. "Within an electronic medical record system, an alert is triggered when a provider orders a new drug for a patient that interacts negatively with another drug that either the physician has ordered previously or the patient is already taking" (Glandon et al., 2008). Problems with information management can prevent clinicians from having real-time situational awareness (SA), which significantly reduces their ability to diagnose and treat. Alerts achieves it goals through an assessment of the scientific evidence on patient benefits and cost-effectiveness and identifying where further research is needed. Another goal is to identify at an early stage, new methods which are potentially of major importance for the health care system. Gillespie states that, the real problem lies with alerts that are not specific enough or that are inappropriate; for example, if an alert about the potential for an allergic reaction fires every time aspirin is ordered, whether or not the patient is allergic, that is problematic." Part of the problem with alerts though is that the knowledge in the system is not updated regularly; if such systems are to be trusted and used, it is critical that they be kept up-to-date and tested. Also, too many alerts are being ignored and overridden (Gillespie, 2010).

Managing alerts means having a governance process for evaluating the clinical relevance and workflow impact of any proposed alert. Special effort is required to understand how alerts are embedded in work flows and the effectiveness of the system's interface for calling attention to and displaying alert information. Left unmanaged, high rates of override lead to a desensitization to the importance and relevance of the recommendation and information in the alert, and defeat the promise of improved patient safety (Clare & Pierce, 2006). The challenge, for vendors and entrepreneurs, is to develop the cognitively effective interface, clinical rules and governance models needed to resolve the problem of alert that are ignored. This ultimately impacts the effectiveness of the entire clinical decision support system.

In reality, very few people would try to deny that effectively managing knowledge is a key driver of quality outcomes and profits in healthcare delivery today. Yet, the evidence suggests our ability to create, use, share, and protect the knowledge needed for healthcare delivery is possibly nearing a point of failure; therefore, new approaches are required. "The most urgent challenges for…[continue]

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