Why Haven’t Electronic Health Records Made Us Any Healthier?

Almost 20 years ago close to 4,000 people from 200 companies gathered in San Diego for a conference to discuss the future of health-care information technology. This was before the Web. This was back when computers in physicians’ offices, to the extent they were present at all, were used only for scheduling and billing patients. Paper charts bulged out of huge filing cabinets.

It was one of the first big conferences held by the Healthcare Information and Management Systems Society (HIMSS). I was among a grab bag of physicians, technologists, visionaries, engineers and entrepreneurs who shared one idealistic goal: to use information systems and technology to fundamentally change health care.

We didn’t just want to upgrade those old systems. We imagined a future that looked a lot like what we were being promised throughout the economy as it sped into the Internet era. Computers would enable improvements in the practice of medicine—and make it safer, higher quality, more affordable and more efficient—all at the same time. We wanted people to be healthier.

Not long after that conference, a group of us began building a company called Allscripts that initially focused on electronic prescriptions. Old jokes about illegible doctor handwriting belied serious safety issues. The Institute of Medicine calculated that 7,000 Americans were dying each year from preventable paper prescription errors.

In rural New Hampshire, an innovative physician named Azar Korbey transmitted the first fully electronic prescription using our system. Today, according to industry source SureScripts, about 600 million prescriptions out of 1.5 billion in the U.S. are written electronically. That’s substantial progress. Electronic prescribing is saving lives. But there is more to do.

The next phase was electronic health records. Allscripts and rivals like Cerner and Epic found ways to automate a complicated clinical encounter. It became a national goal to make all physician practices and hospitals digital.

This didn’t seem out of reach. After all, computer visionaries like Bill Gates and Michael Dell talked about how computers would change everything. But we (and they) soon realized that putting PCs on every desk was only the first step in the information revolution. It wasn’t until we connected those computers together using the Internet and developed “apps” that everything changed about the way we work and play. Remember Amara’s Law: “We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run.”

Two decades later the question is being asked: Did our industry succeed in doing what we said we would do?

The process of getting from zero to nearly half a million physicians using electronic health records systems has been arduous. To paraphrase Churchill, this is not the end. It is not even the beginning of the end. But is it, perhaps, the end of the beginning of the electronic health revolution.

We’ve seen people knock the value of our investments in these systems, criticize the government’s stimulus, and question the return on investment. David Kibbe, a physician and technology advisor to the American Academy of Family Physicians, wrote in an open letter to President Obama that electronic health records are “notoriously expensive” and “difficult to implement.” Arguing against subsidies, Kibbe wrote: “Nor is there conclusive evidence that the use of EHRs improves patient care quality.”

But does anyone really believe we should go back to paper? In fact, more than ever, people understand that making digital records work is critical to fixing health care. The annual Healthcare Information and Management Systems Society (HIMSS) conference, held last week in New Orleans, expected 35,000 people and 1,000 vendors to focus on that task.

The President’s Council of Advisors on Science and Technology concluded in a recent report that “the impact of IT on health care over the past decade has so far been modest.” The key words: so far. Investors and the industry would be wise not to underestimate what’s coming. It is nothing short of an explosion in innovation and creativity, facilitated by open systems and connectivity.

What the Council found is that the technology can fix itself. As these systems, which doctors and hospitals have spent billions to install, begin to talk to each other and to patients, everything will change. Right now, as the report says: “The ability to integrate electronic health information about a patient and exchange it among clinical providers remains the exception rather than the rule.” This is exactly what needs to change.

Remember when the RAND Corporation predicted $80 billion a year in annual savings and 285 million fewer sick days? I’m here to tell you that will happen, and sooner than you think. Intelligent policies out of Washington that force vendors to connect and interoperate (just like our bank ATMs and phones do) and hospitals and physician buyers demanding the same will fuel this revolution. Most important, patients will not be patient anymore. They will begin to demand access to their own information and their own records.

So what does our community need to commit to accomplishing?

First, we have to finish the job of getting physicians on board. The CDC reported in December that 73 percent of physicians now use electronic health records, up from about a third two years ago. So we have made great progress, but still have too many physicians using paper.

Then we have to get these records connected to each other. The industry, through HIMSS, and the government, through the Office of the National Coordinator, are pushing for interoperability. With the exception of one or two, most vendors are falling in line. Medicare, insurers and consumers will have to exert pressure, since individual players may benefit from locking down their own data. But once the network is open, we’ll see the same exciting progress that we’ve witnessed in our lives outside of health care.

Meanwhile, the systems that have already been installed need to work better. They’re still not easy to use, and this is coming from someone who spent 15 years developing and selling them. The industry can do better, and the industry will, especially with the development of new iPad and other mobile apps. And we have to fundamentally change the electronic health records. Today, they tend to be “information retrieval” tools. “What you see is what you just wrote,” is not the kind of value we should be adding. The computer does not help the doctor practice better … yet. The patient does not learn much from the data … yet.

But once records are open, connected, and more user-friendly, we can start to add intelligence to the network that will help doctors, nurses, care coordinators and patients all do a better job improving health, not health care.

We see it happening. Innovative companies like dbMotion are connecting disparate systems across health care organizations. Other innovators, like Humedica (recently acquired by OptumHealth), are learning how to mine data for insights that will help physicians and care coordinators keep track of large panels of patients. Health care will soon be brimming with similarly exciting start-ups producing apps that change everything.

Medical apps that dial into electronic health records are finally starting to become ubiquitous. This will impact cost and quality in very significant ways. For example, a physician’s $199 iPhone device can avoid orders for $150 electrocardiograms. (See this video for a demonstration by Dr. Eric Topol). Or a wireless scale can notify a nurse when a congestive heart failure patient gains weight indicating dangerous fluid retention.

Think about wearing a device that allows your vital signs to be remotely monitored all the time, rather than at a once-a-year doctor visit. Pair that data with intelligence from IBM’s Watson, being used by innovative health-care organizations like Memorial Sloan Kettering to provide their teams with better information to provide better care, and the result is a whole new system of care.

Arthur C. Clarke said, “Technology, properly applied, is indistinguishable from magic.” It is the “applied” part of that dream we are still working on. But I’m confident we’ll get there. A connected system will help patients take responsibility for their health. Strong teams of physicians, nurses and caregivers will use an intelligent network to make their results better and their jobs easier. It does sound like magic. And we are getting closer each year. Just take a walk around HIMSS and you’ll see the future.

Glen Tullman is the founder of 7Wire Ventures, an investment firm that creates new businesses and invests in early and growth stage companies. He was previously CEO of electronic health record company, Allscripts. This post originally appeared in Forbes.

18 replies »

  1. I have read some just right stuff here. Certainly worth bookmarking for revisiting.

    I wonder how so much effort you place to create
    any such magnificent informative site.

  2. I agree 100% – each person is responsible for their own health. We have all the info we need to be healthy – people do what they want to do – each person has control over their own behaviour and most have no insight into their beliefs.

  3. When medical records started to going online and other ways that was supposed to make it easier to track, you knew it would take a while until we actually saw some effect on people.

  4. Speaking about the problems of paper, will Congress with Glen’s testimony come up with a HITECH solution for toilet paper?

    I for one, have had to use more of it, to clean out the bovine excrement hyped by the HIT industry. LOL

  5. I am shocked, literally shocked, that paper is so maligned. There are huge advantages to the physician from an organized paper chart supplemented by digital results and images. Those spouting about the magic of HIT ought to prove it with trials and ought to use some of the magical experimental devices they have sold. Then, look at the complaint v Allscripts, Mr. Tullman’s former company and its device call MyWay.

  6. Finally! a sane voice in the healthcare jungle. All the talk of population health management, patient centered medical homes, accountable care organizations, ignores the fact the providing health care to people is like herding cats! People will do what they wanna do! Why? Because all this innovation, technology, how to transform medical care delivery, providing value to patients/payers, financial incentives/disincentives, all do not acknowledge the fact of people’s Health Beliefs.

    Some people embrace the health care, following treatment plans, working to maintain health, others believe that going to the doctor ALWAYS ends in bad health news, others believe Internet health advice over the providesr, but almost all want a CURE, to be healed and never want a diagnosis of a chronic condition such as asthma, allergies, osteoarthritis, etc, not mention paying for medications. Also all the ethnic cultural beliefs brought into the treament picture.

    When I first became a provider, I was flabbergasted when college education patients asked if taking a course of blood pressure medication would cure their condition. I thought people understood this. Now my answer to patients with chronic diseases requiring daily medication who ask how long do they have to take the medication, I answer, “Until there is a cure or something better.”

    All the technology and even IBM Watson’s can’t control people’s behavior and beliefs. I wait for the day went Watson gives up because of people’s behaviors when it comes to medical management.

  7. ” I was among a grab bag of physicians, technologists, visionaries, engineers and entrepreneurs who shared one idealistic goal: to use information systems and technology to fundamentally change health care.”

    Health care has been transformed, ok, but not for the better.

    Smoke and mirrors is what I see. When there is a system in place to report and record all of the adverse events, injuries, deaths, near misses, delays, system unavailability, and errors associated with the transformation by HIT, you will see that HIT has caused as much harm as good, but you are much wealthier for it, Glen.

    That money would have better transformed health care by purchasing medication for the indigent and providing more nursing care for the sick.

    Tell us about the My Way problems, Glen. Thanks

  8. Because they suck. They are not usable by practicing docs unless you are able to spend a lot of time on them. Even then, they still mostly suck.


  9. Can any physician make a patient healthier? Why is all the attention focused on the physician – isn’t the patient the one who will do something different – maybe fill and take the medication and note if it’s helping or not or causing adverse effects – and then responding to their change in condition? In education there is a lot (maybe too much) attention paid to the teachers’ actions and not enough on what works with students, but at least in classrooms there’s some sense of how students’ behavior and level of knowledge are changed by teachers’ influence. I couldn’t help thinking you aren’t even asking the object or consumer or whatever you want to call the people on the receiving end of healthcare how this technology is influencing them, helping their experience. Maybe that’s the place to start.

  10. Just because Electronic Health Records (EHRs) have been a disappointment so far in many categories, do not confuse this problem with some of the great recent successes in the advancements of new portable clinical and biomedical technologies such as Electronic Diagnostic Tools (EDTs). New electronic detection devices, such as electronic-nose (e-nose) devices, based on various types of electronic aroma detection (EAD) technologies, are beginning to revolutionize the methods and practices utilized in human disease detection as well as many other biomedical applications. To learn more about this exciting new area and examples of successes in portable electronic devices used in healthcare and clinical practice, please consult the following two review articles:



  11. Glen –

    Not sure what you can or cannot say after your departure, but what advice would you give to the next generation of EMR developers? Where would you like to see the industry headed? Anything you wish you’d done differently with the benefit of 20/20 hindsight??

    Something to address in a future post perhaps …

  12. EMR’s are a method for non-clinical people to extract resources from the health care system, such as it is.

  13. I like this bit, “Intelligent policies out of Washington…” Yup, that’ll improve our health.

    When will HIT remove salt, sugar and fat from our corporate produced processed food? That will really improve our health.

  14. Peter1 – Because most of what we do with current medical interventions has little impact on health outcomes. But who wants to dismantle a 2.2 Trillion dollar industry?

    Dr. Rick Lippin
    Southmpton, Pa

  15. Why hasn’t spending about twice what the rest of the industrialized nations do on health care made us any healthier?

  16. Respectfully -you missed the fundamental reason why HIT/EMR is “not making us any healthier” (the question posed in your title)

    For profit firms have dominated the HIT/EMR landscape. And where profit dominates health becomes increasingly secondary if not irrelevant.

    Dr. Rick Lippin