As enterprise software systems—systems which satisfy an organization’s needs, as opposed to individual needs—pass from the early-adoption stage and into widespread market acceptance, the software itself will mature and change along with users’ expectations. Electronic medical record (EMR) systems will prove to be no exception, particularly since they are under the scrutiny of so many different types of users in the healthcare system, from laboratorians to physicians to allied health professionals. The very ubiquity of EMRs in the hospital will accelerate the progression away from what is called a “black box” system, a closed system which does only what the software developers coded into the software. There will always be a market for “hard-coded” products, especially for smaller organizations that lack the resources to customize their systems. But the hard-coded approach has a significant drawback: the hospital must change its procedures to match the software developer’s vision of the required functionality.
Most EMRs today offer customization to a limited degree (and I do not mean add-on modules at additional cost). Vendors at the top end of the market offer strong “out of the box” architecture; it works the way the vendors designed it. As the industry matures and EMRs need to be more things to more people, the next generation of systems will keep pace with the next generation of software users: savvy, computer-literate healthcare workers who are already accustomed to doing a certain amount of customization to get the software to work the way they want it to work.
The new EMR programming interface will be less of a legacy API (application programming interface) that only code gurus thrive on. It will morph into a friendlier and more intuitive system which allows for a more flexible architecture created by healthcare professionals, not software professionals. This will enable users to get under the hood to a certain extent, so they can expand the software’s functionality to match existing procedures, rather than change procedures to match the software. In this way, frustrations that some users have with current EMRs will directly and meaningfully drive change in the way that the software works.
Flexibility will manifest itself not only in the way that the software works, but in the way that it is deployed and upgraded in the hospital. With the majority of hospitals now using EMRs to some degree, users often report frustration with implementation delays, bugs, and resultant downtime. Those reports get aired in EMR Best Practices guidelines, forums, and user groups, making a readily available source of user feedback that has and will continue to prompt improvements in the roll-out process.
There is a direct financial benefit associated with that change. Many organizations did not see the cost savings they were led to expect from converting from paper to EMR. But more and more, we’re seeing costs coming down for system maintenance, backup, storage, network requirements, and training, as well as streamlining of the deployment process. Cloud-based technologies enable faster deployments and smoother upgrades which are less dependent on heavy investment in a home-grown and home-hosted IT network, with all its attendant hardware and infrastructure costs.
Finally, the principle of user-driven flexibility will make itself felt in the output. EMRs will no longer be black box systems that spit out reports which are incomprehensible to the actual end recipient: the patient. More and more EMRs (or users who are customizing EMRs) will be able to generate on-demand, takeaway information that is customized for the needs of the patient, using conversational language and non-clinical diagrams and charts. As the top EMR vendors engage in the inevitable “function arms race,” one byproduct will be that more EMRs will be able to speak to the patient using a narrative approach that brings together all of the patient’s clinical information in a way that he or she can understand and use.
For example, imagine being able to generate a printout that lists all of the patient’s major health issues, along with associated risks and suggestions about how to manage his or her own care—in a language-of-choice that the patient understands and can take home. Or imagine being able to give the patient a mini-poster to put on the fridge that graphically illustrates his or her triglycerides or blood sugar levels over time, explains what those things mean—and relates them to the food the patient is about to choose from the fridge.
The enormous potential of EMR is evident to any user who interacts with it. Today’s clinicians, with ubiquitous software devices at their fingertips in the form of cellphones and other mobile devices, have much higher expectations of any software systems than earlier generations had. Those users will demand EMRs that deliver the promised cost savings and time savings.
That demand will be met as EMR vendors respond to user feedback by streamlining their development and implementation processes. Users will also be able to customize the EMR through a better, more intuitive toolset to expand the EMR beyond the vendor’s initial configuration. Last, they’ll call for the EMR’s final output to be intelligible and useful to the ultimate consumers—the patients—giving them flexibly configured information that helps them take a more active part in their own healthcare.