Insights: Electronic Health Records

[MUSIC PLAYING] SPEAKER 1: A secure, interoperable electronic health record system can save time and money and improve the quality of health care. SPEAKER 2: I'm excited SPEAKER 3: I am excited, but I'm a little nervous. REP. LYNN JENKINS: -- health records, they can better coordinate care-- SPEAKER 4: It is increasing your ability to collect data, but somebody has to put it in. DR. CAROLYN CLANCY: If poorly designed or implemented, health IT will not bring these benefits. SPEAKER 5: How many of you love your EHRs and couldn't imagine living without it? Any of you? [MUSIC PLAYING] SEEMA VERMA: We're hearing the frustrations of doctors across the country. These electronic health care records weren't necessarily built to help doctors, so it doesn't necessarily flow within their clinical workflow. And so it's actually creating more work for them. FRED SCHULTE: Doctors are concerned that they're spending more time clicking and pasting and typing than they are looking at their patients and interacting with their patients and learning about them and trying to, you know, them. BOB KOCHER: The EHR had the potential, I think, to make them more productive and sort of make invisible some of this complexity that, in fact, they've surfaced and made it, I think, more annoying to doctors. And that leads them to be less satisfied. The user experiences defy logic and surprise me for why they're so cumbersome to use. ILANA YURKIEWICZ: When I meet a new patient, it's like opening a book to page 200 and being asked to write page 201. Maybe on top of that, pages 25 to 50 are mysteriously ripped out, pages 75 to 90 are out of order, and pages 100 to 110 are shuffled. FRED SCHULTE: You can get to the point where you say, you know what, I've had enough of this and it's-- I'm too stressed out. I'm too burned out. I'm worried about making a mistake. I'm worried about hurting a patient. And they say, you know, forget it and I'm going to retire. [MUSIC PLAYING] ILANA YURKIEWICZ: I think the hardest part of patient care shouldn't be data collection or data entry. That part should be taken care of by the system, so that then we can focus our attentions on the things that really matter, like making decisions for patients and communicating with patients. RAJ RATWANI: A clinician that's burned out is more likely to make an error when they're doing their job. And what that means is patients could unintentionally be harmed because of that error. FRED SCHULTE: In electronic health records, you hear a lot of complaints over these long pull down menus, where you have to pull down and there's all these potentials, and you can click the wrong one. RAJ RATWANI: If you're a physician and you're placing an order for Tylenol, you might search for Tylenol by typing that into the search menu in the electronic health record. And in some systems, when they do that, you get 86 different results back for Tylenol. And there's some serious consequences to that, beyond just the frustration of having to look for the medication that you want. It introduces what we would call cognitive burden, which is that you have to process all this information every time and be really careful about the information that you're selecting. And that wears our clinicians out. And the second, because of that burden, is that it's very likely that an error might be made. You might select the wrong medication because the list is so complex. ILANA YURKIEWICZ: The more clicks there are and the busier health professionals are, sometimes people will just click through without being as thorough as they should be, which kind of negates the whole purpose of why these alerts are there in the first place. JON LOMURRO: The problem is is that they're just inundated with data, that they feel like it's overload and shut off the warnings as opposed to embracing them. ILANA YURKIEWICZ: --which might sound silly to people who aren't sitting on a computer all day, but for people who actually do this and would rather be spending time with their patients, if it takes 30 clicks just to order a really simple medicine, sometimes the alert fatigue can become overbearing. [MUSIC PLAYING] ERIKA FRY: Burnout is such a crisis because these professionals are-- their job is one of the most high stakes in America. They're working with humans and our health. And if they're not, you know, satisfied or engaged at work, that's a real problem for all of us patients. Earlier this year, the Harvard School of Public Health, as well as the Massachusetts Medical Society, declared physician burnout a public health crisis. Some 78% of physicians, according to one study, suffer from symptoms of physician burnout. And that's a really bad thing when we have a large majority of doctors in America that are feeling disengaged or really frustrated at work and not totally on their game. So the good news is that pretty much everyone acknowledges these problems exist. There's lots of innovation going on around the system, so developers are coming into this space and trying to build on to the existing systems to make them more efficient, to make them work better. One researcher in Washington DC, Raj Ratwani, he studies human factors. They are basically how humans interact with technology. He's trying to bring public awareness to this issue of errors in electronic health records and the need to make the systems more usable. RAJ RATWANI: So when we're looking at electronic health record usability and safety, we use several different methods to study what's happening. And one thing that we do is we use what's called eye tracking technology. And that's really important for us because it helps us understand where they're allocating their attention, what are the things that they're paying attention to, what are the things that might be distracting, and how do those relate to potential errors that might happen. We also use some technology that's physiological sensor devices. A little bit of stress is good, a lot of stress is bad, and that contributes to this burnout challenge. And so these sensors allow us to see what tasks are being performed and which ones are associated with higher stress levels. The key piece here, as we move forward, is that we make sure we keep the human element in mind. And we want to make sure that it stays human-centered, that the technology is built to meet the needs of patients, and that it's also built to meet the needs of physicians, nurses, and even other care providers. [MUSIC PLAYING] ILANA YURKIEWICZ: Progress is slow and that can be frustrating. And I think it's easy to focus on the negatives and on what's missing from our electronic records. I am hopeful, with the right focus and really understanding what the problems are, and the right leadership, that we can make progress. You know, the electronic records have improved a lot of things for patients and providers, but we're still pretty far away from a universally shared system of records. [MUSIC PLAYING] 

The deeply flawed Electronic Health Record system in America has contributed to the "burnout" epidemic among medical professionals.

Insights: Record Doctor 'Burnout' Attributed to Electronic Healthcare Records Push' (4/4)

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EHRs have contributed to "burnout" medical professionals

Record Doctor 'Burnout' Attributed to EHRs Push

[MUSIC PLAYING] SPEAKER 1: Each and every patient in the view of Congress believes, as I do, the patient has a right to access their own health care for whatever reason they want. I was stunned when my son, for a year, was battling Stage 4 Glioblastoma. I couldn't get his record. I'm the Vice President nine states of America. A lot of you were very cooperative. I couldn't get his records. It was a absolute nightmare. [MUSIC PLAYING] ERIKA FRY: When the government invested all this money in electronic health records, there was tons of excitement, the promise of really transforming medicine for the better. People were so excited about that. And what happened with the very quick adoption of electronic health records was, some of the software was not actually ready to be implemented in a health setting. RAJ RATWANI: There were clear benefits, but there were also some challenges. And one of those really big challenges was usability and safety, and usability is how effectively, efficiently, and satisfactorily the technology can be used. The poor design of a charge that's sub-optimal with usability can actually lead to direct patient safety consequences. FRED SCHULTE: There's a balance. I mean, on the one hand, there are all these positives that could be accomplished through a system that really works well. But yeah, if you have software breakdowns and nobody is monitoring them closely to make sure that they don't keep happening, you could in fact have very, very severe repercussions from that. Tara Dilliplaine is the mother of Brooke Dylan Dilliplaine who was a 13-year-old girl with a number of medical problems, who had to make frequent trips to the hospital for treatment. TARA DILLIPLAINE: Brooke was 16-years-old when unfortunately we lost her, but she was just a beautiful soul, absolutely beautiful soul in and out. And she had a very tough life medically, physically. I couldn't even tell you how many times she was in the hospital in her lifetime, but it was a lot. We had Brooke going into the hospital for a routine EEG. It's a 24-hour study that will test her brain waves, and while we were there, the hospital gave her two doses of a probiotic that had dairy in it, and Brooke was severely allergic to dairy. So she had two severe allergy reactions while we were there. She went into complete respiratory distress. Her lung collapsed. And while I was there and this was going on, I was researching on my iPad what could be happening, and I was the one that realized that they gave her a product that had dairy in it. ERIKA FRY: Tara argued that they have this electronic health record system that has in the system somewhere, that her daughter was allergic to milk yet she was given a drug that contained that ingredient. FRED SCHULTE: They had said that the milk is an active ingredient, they can't warn about everything, and that they deny that there was anything wrong with their product. And that was their position. ERIKA FRY: With these sorts of cases, it's hard to assign blame. There's this human error, can you blame it on the technology that's supposed to be smart enough and flagging allergies? The great hope for electronic health records was that it would be able to catch these sorts of events. TARA DILLIPLAINE: From what we understood, this is not the only hospital that uses this type of software. So it is everywhere. It's nationwide. And it breaks my heart just to think that there are other patients that are going through this. ERIKA FRY: So beyond the safety risks with the HRs, we found that patients really struggle to get their medical records, and that's especially the case when they've had something happen to the hospital and they're trying to get information on what might have happened. TARA DILLIPLAINE: This EEG is a video and an audio clips of the entire thing, and I had recommended that they watch it so that they can see exactly what went on with my daughter. When we tried to get a copy of it, they told us that it was already erased and they only held on to any seizure activity. So we weren't able to get a copy of it. We ended up going to a lawyer. BOB KOCHER: Patients today are expected to be the experts at their care and put it all together, and know who to listen to, who to work with, and who to find. RAJ RATWANI: I think most patients have never seen an electronic health record. It's not something that we think about on a daily basis. That's something we want to be thinking about on a daily basis, but because we're starting to see this association between electronic health record usability and safety and potentially patient harm there, this is a really important issue. JOHN LOMMURO: I have yet to find a patient in five years ever get the records since they were required to do so in electronic format without prolonged litigation of several years to get it. The patient has to be their advocate. Why not give the patient the opportunity to catch something that somebody misses? ERIKA FRY: Patients struggle to get their medical records for several reasons. For hospitals, it's not in their best business interest to share records. That's what a lot of people argue. They want to keep their patients within the system that makes them hesitant to share patient data with other hospitals. The other issue is hospitals don't love to talk about safety issues within their own walls. But in reality, the reason why patients really struggle to get their health records is a mystery or is something that widespread. Adoption of the HRs are supposed to make happen and we are yet to see it. TARA DILLIPLAINE: Electronic data, it seems like it would be so promising on so many levels. I know for us, we were hoping that we would have one focal point that would bring all of Brooke's records together from so many specialists, but it proved to be that we really couldn't get access to all of that. So I still think there's such a long way to go in terms of electronic data. For anyone that walks through those doors, they deserve to be protected and they deserve better treatment than what my daughter had on those two days. [MUSIC PLAYING] 

Electronic Health Records' potential for patient care seemed limitless - but in reality technical and design flaws have led to serious patient risk.

Insights: Patient Safety Consequences of Poorly Designed Electronic Health Records (Part 3/4)

Fred Schulte, Llana Yurkiewicz, Bob Kocker, Erika Fry

The design flaws of EHR's have led to serious patient risk.

Patient Safety Consequences of Poorly Designed EHRs

 - It's now been 10 years since the EHR and center program was created, yet we still do not have adequate levels of interoperability. - So we can sequence the entire human genome, but we still can't get much more than a printout, a fax, or CD Rom when we leave the doctor's office. - But often we are delivering care with a fractured medical record. - The electronic health record unfortunately, was introduced as a halfway technology. - The promise was that everybody in America, would be able to have their own personal electronic health record, you'd be able to monitor your health more closely, you'd be able to communicate back and forth with your doctor. And for most people, that hasn't really happened. ILANA YURKIEWICZ: The whole goal or one of the major goals of converting paper records to electronic charts was, ease of data entry and retrieving data, so that this can be shared in a straightforward way. BOB KOCHER: Question is why is it so hard to get your information, I mean it's your information that is in the computer? Should be like, select and print, and get it. ERIKA FRY: Interoperability is the term the industry uses for do these systems, communicate with each other, can they share health data with each other. And right now, we're trying to get to a very basic level of interoperability, which is to send and share very basic data sets. The idea that all the information in one system can be shared with another, is a long ways off. FRED SCHULTE: The idea of interoperability used to have sort of a seamless national system in which health data can be shared by vast quantities. Both for the treatment of diseases and for the ease at which you can have your records sent or someone can send the records on your behalf. That could save your life. - The interoperability problem is one that's been more and more intractable than I expected. And so I think we probably should have thought about ways at the beginning, require it. At least, for some aspects, for safety, to require it. Because the economic incentives are such that it's hard they could make that happen on its own. ILANA YURKIEWICZ: We have hundreds of different electronic vendors in this country. And they often all operate independently. JON LOMURRO: Why should epic this huge company have to share its information with EMR 2 or whatever you want to call this local. GALEN MULROONEY: Historically, there have been a lot of proprietary coding systems that were built as part of products. There are about five or six well-known companies, all of whom invested millions of millions of dollars trying to get that information correct and that knowledge is proprietary. And they rightfully, don't want to give it up. ILANA YURKIEWICZ: While most doctors offices and hospitals have gone paperless and they use electronic records, those records are not shared or integrated with other facilities. SEEMA VERMA: Essentially, where is your information was in a filing cabinet. Now, it's in an electronic filing cabinet. So we don't have a system where data is traveling seamlessly with the patient as they go through the health system. - Hospitals don't want their patients to go across the street to the competitor really easily. And so they make their computers not share all the information because they don't want the patients to leave. ILANA YURKIEWICZ: When I first started in this role, I think I had this naive expectation that all of the information that I wanted and needed to properly take care of patients would be available to me in an easily accessible formats. It didn't take long before I figured out that, that's not at all the case. In order to get information about our patients, we need to do a lot of sleuthing, and a lot of legwork, and a lot of obtaining outside records and information. And that process can be very cumbersome and it can take a long time. - There were so many, very quick installations of this equipment to recoup the stimulus money. There were doubts and questions, and still are questions whether in fact, the requirements were being met by some of these vendors. - Very careful checks have to be done to make sure that the patient safety checks are operating properly. JON LOMURRO: I got data coming in from another system and there's something wrong in that data, that's misinterpreted my system, now, all of the fanciest clinical decision support systems that I just spent huge amounts of money and time on, are going to misfire. And it's either going to not tell me to do something when it needs to or it's going to tell me to do something when I shouldn't. And you know that's dangerous, you could kill somebody. - There's been a lot of examples in which the electronic health records have mixed up patients and put information about one patient in the wrong file. You get other situations in which doctors order a test. And then by some kind of a software glitch, it disappears before it gets sent to the lab. And so the doctor could be waiting around for a test result, and not realize that the test never got to the lab. - So there are a couple of important things that need to happen to improve our usability and safety. So the first one is, we have to have more effective HR usability and safety testing. The second important piece is that, many of the contracts that exist between HR vendors and provider organizations, health care provider organizations contain language that are often termed gag clauses that prevent the open communication and sharing of usability and safety challenges. FRED SCHULTE: There's just been a culture of complete secrecy in this industry, which has prohibited a lot of people from honestly talking about the problem. There's confidentiality clauses that say pretty threateningly, that you're not to share any information about how much you paid for this system, about any problems you see with the system. You can't really call your buddy at another hospital and say, you know we installed such a such a system. And man it's garbage. - The companies say they're protecting intellectual property, but many safety experts say, this really is preventing wide spread learning on these safety risks. - The driver of everything, the most important person in this entire story, is the patients. And just like doctors and nurses should have access to all of their information in a way that they can make informed health care decisions. Patients need access to their own information too. So they can manage that properly, bring it to other providers, or just have it for their own-- for their own sake and their own knowledge. - We could somehow find a way to put the patients first, then the opportunity is there. Because if everything is recorded and everyone listens to flags and warnings, then they will catch things we can't even dream of. And that's fantastic. 

Years after their adoption, electronic health records still haven't lived up to their potential.

Insights: Why Electronic Health Records Failed to Become a Nationwide Network

After adoption, EHRs still lived up to their potential.

Why EHRs Failed to Become a Nationwide Network

 SPEAKER 1: The story of the interoperable electronic health record starts in 1998. GEORGE W. BUSH: By computerizing health records, we can avoid dangerous medical mistakes, reduce costs-- BARACK OBAMA: We will make the immediate investments necessary to ensure that, within five years, all of America's medical records are computerized. JOE BIDEN: Further the use of technology in improving our health care system. JOHN ENSIGN: Electronic medical records just makes sense. [MUSIC PLAYING] BOB KOCHER: In the midst of the great recession, there was a giant opportunity to spend money in America to help us get out of that recession called the American Reinvestment and Recovery Act. And in that act, we had an opportunity for health care to have a section which offered doctors incentives to buy and then use alternate health records. FRED SCHULTE: Obama represented a new way of thinking on a lot of fronts, and one of them was technology. This was something that he saw as long overdue. That every other industry was computerized, and it was just outrageous and stupid that we have all these paper files sitting in file cabinets that are doing nobody any good. So what Obama did is he decided to put money behind it. BARACK OBAMA: The Economic Recovery Plan I'm proposing will help modernize our health care system. And that won't just save jobs, it will save lives. We will make sure that every doctor's office and hospital in this country is using cutting edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes, and help save billions of dollars each year. RAJ RATWANI: And so in 2009, the federal government, Congress, passed what was called the HITECH Act. It stands for the Health Information Technology for Economic and Clinical Health Act. JON LOMURRO: The goal of HITECH was, by 2015, every single person in America would have an electronic health medical record that would be transferable. ILANA YURKIEWICZ: So the goal is to improve patient's safety and to create a system of easily accessible information that can be as useful as possible for providers to make safe and informed health care decisions for their patients. [MUSIC PLAYING] DAVID BLUMENTHAL: I'm pleased and excited to say that the registration process is now open for health care providers to obtain significant incentive payments for adoption and meaningful use of electronic health records. RAJ RATWANI: As part of the process of promoting electronic health records, a certification program was set up. And that certification program provided, essentially, rules by which technology needed to be developed in order for it to be tied to reimbursement payments by the federal government. ERIKA FRY: For doctors to get the federal payments for adopting electronic health records, they had to prove that they were using the electronic health records in a meaningful way. BOB KOCHER: If they bottom out their health record, on year one, show that they used it. In year two, used it to more effectively affect patient outcomes. And then in year three, to really be a more effective doctor. LAMAR ALEXANDER: To receive incentive payments, physicians and hospitals had to buy systems certified to federal government specifications. Providers assumed that the certified systems would be high quality and meet program requirements. BOB KOCHER: Well, we certainly thought when you provide $44 billion of incentive for people to buy software products, that the industry is going to grow a lot. And not surprisingly, there was a lot of growth in the industry after the HITECH Act was enacted. ROSS TEAGUE: The requirements that were there in terms of meaningful use. The time frames that were there. A lot of things got built that were built to check the box of meeting that and getting it out the door in time for people to be certified and meet that. And so, when things like that happen, when you rush-- when you rush, things can-- Unintended consequences can be one of the downstream effect of causing someone to do that. ERIKA FRY: So there was software that didn't work the way that the companies said it did. They had taken shortcuts in order to meet government requirements, and so there were actual software defects. FRED SCHULTE: There was tons of requirements and regulation, but I think that critics might say that they weren't the right regulations. I think that they needed to make sure that the products were, in fact, safe. And they needed to rapidly-- in the view of critics-- rapidly investigate any failures to make these systems better. ERIKA FRY: Poor EHR design and poor implementations of the systems have really led to some horrible cases of suffering, injury or death. [MUSIC PLAYING] LAMAR ALEXANDER: The hope was that the program would improve care, coordination and reduce costs. The evidence suggests these goals haven't been reached. A medical economic survey last year found nearly 70% of physicians say their electronic health record systems have not been worth it. One physician wrote, "we used to see 32 patients a day with one tech and now we struggle to see 24 patients a day with four techs," and we provide worse care. FRED SCHULTE: That nobody could dispute that putting all that money out there did, in fact, get people to install this equipment. But it wasn't just about installing computers in doctor's offices, it was about all these other things, like having interoperability, having ability to forage through vast amounts of data to find new treatments for disease. So there were all these other things, and those are the things that really haven't been accomplished. [MUSIC PLAYING] 

When the American healthcare system began to transition to Electronic Health Records, policy makers saw a future full of potential and possibility.

Insights: Electronic Health Records Created "Not Solved" Problems (Part 1/4)

Bob Kocher, Fred Schulte, Raj Ratwani, PHD., Jon Lomurro, Llana Yurkiewicz, MD, Erika Fry

Policy makers saw the potential in American EHR's transition

Electronic Health Records Created "Not Solved" Problems

[MUSIC PLAYING] AMY ABERNETHY: A lot of the information on electronic health record is nonsense, or cut and paste errors, or at least is represented in digital documents that are otherwise not analyzable. And so one of the core tasks is acknowledging that we've got a data quality problem and we have to work really hard in a systematic fashion to clean up the quality of the data. The data that we're talking about being aggregated and being put to secondary use, those secondary uses are not going to have value and are not going to be credible unless the underlying data quality problems are solved. And that's not just getting doctors to enter better notes. It's actually doing the hard work of cleaning up the electronic health record data. So I think we need to acknowledge that that's a task at hand and go for it. The second thing is when you pull together data sets, like, when we smash them all up, the problem is that mashed up data is just-- I always imagine you're just dumping a whole bunch of stuff in the kitchen soup. And now you've got to figure out how to make sense of it all. And so the nice thing about the electronic health record, when you clean up the data, is it gives you longitudinal context of what happens for an individual patient that forms the backbone upon which you can now put all the rest of your data sets. Because one of the big issues in this whole world of moving towards big data is big data and context is going to be the most important data sets of our future. 

Dr. Amy Abernathy discusses data’s growing role in the healthcare industry.

Insights: Healthcare Has a Data Quality Problem

Dr. Amy Abernathy discusses data’s role in the healthcar

Healthcare Has a Data Quality Problem

[MUSIC PLAYING] MICHAL LEV-RAM: Let's talk a little bit about the security and privacy side. And I know the three of you all have opinions on this and probably somewhat different approaches. Eric, maybe we can start with you. In an ideal world, how do companies go about making sure that privacy and security are, first and foremost, top of mind when they're developing these technologies? And I know you've talked and written about how patients, consumers, should own their data. What does that world look like and is that the only solution? ERIC TOPAL: I think, ultimately, it's the only solution, that people have to own your data, because what we're seeing now is the worst case scenario, where data is sold, it's stolen, hacked. Cyberthievery is rampant. And our medical data is at least 5x the worth on the dark web as our personal financial data. So we have a situation now which is not acceptable. And if you talked to cyber gurus, they will say, you got to get it down to units of one, or the smallest possible units. Whereas, of course, it sits on massive servers that have indeed been hacked. And so many health systems have been held hostage for their data. So that requires a fundamental change. We've seen it in other countries like in Estonia and Switzerland. And other countries are adopting this ownership model, where people can share parts of their data with certain-- whether it be physicians or medical research projects or that sort of thing. Eventually we will go there because this will have to be considered a civil right. That is your data, you paid for it, and all the other things that it could change your life. But in the era of AI, it's the inputs. If you don't have all this data, which is in the US, it's all over the place, from various doctors and encounters throughout one's life, then you have a compromised input. And you can only expect so much as an output. So that's why we have to move to a different method. And we're a long ways from that today JESSICA MEGA: I think two key issues. One, is when you're dealing with health data or life science data. I'll use the example of devices. If you think about a pacemaker, or an ICD, or a continuous glucose monitor that is giving medically great information to a person who may change their dose of insulin, for example. We have to be 100% sure that this is actually their data. So again, I think understanding cybersecurity in this age is critical, and you're seeing groups across the board championing that. I think on the ownership, I would even say and take it one step further, how do you actually give value back to people? So not just surfacing a lot of medical data, but saying this is what it means for you. Here is your continuous glucose data. You ate a certain food and here's how you can make healthy choices. I think the more we think about not only the data, but value, that's an ambition that we've had from the beginning. ERIC LEFKOFSKY: One of the biggest problems you have as a patient, in terms of ownership of your data, is what do you do with the data. First of all, it's a huge amount of data. And second of all, it's largely unstructured. And what ends up happening, is you as a patient, when you get your hands on your data, you're often e-mailing it to a physician and they have no ability to import it back into their EHR or EMR system. So there is no interoperability or transferability of this data. And so I think even though the patient should own their data, and they certainly have a right to it, and even the provider should be able to house that data seamlessly, probably the bigger challenge we all have to tackle is the underlying infrastructure that allows us to move around this kind of rich clinical data seamlessly across providers, across positions, all of which is entirely today broken and siloed. But again it's likely to be fixed by these really massive technology currents that are just there. So with NLP and OCR and all these great technologies, we will likely be in a place in a very short number of years, where this data can be structured on the backend and moved between an Epic, or a Cerner, or an Allscripts, or an OncoEMR, or pick your provider. And that I think is going to be one of the biggest unlocking of patients being able to put their data from one doctor to another. [MUSIC PLAYING]

Electronic Health Records have the potential to streamline care, but they also come with big risks. 

Insights: Electronic Health Records Raise Big Privacy and Security Concerns

Electronic Health Records could potentially streamline care.

EHRs Raise Big Privacy and Security Concerns

[MUSIC PLAYING] DAVID AGUS: When I see patients and I sit in a room, and many of your thousands of doctors do the same, we spend a good proportion of our time taking data and information and putting into electronic health record, where it gets squared away. We can't do a thing with it. Why aren't you guys taking on the electronic health records? Why aren't you challenging them so we don't have to have that data siloed in some server somewhere. That we collect it in standard data elements, that we could put it in a structured way and learn from it and improve patient care. There seems to be an impediment and nobody is standing up. LLOYD MINOR: Well, perhaps, I can start and then welcome comments from the panelists. We agree with you completely. We hosted a conference at Stanford in June of last year on the electronic health record. We had people from CMS, HHS. We had some representatives from the EHR companies. Interestingly, some chose not to participate. I meet a lot of people from the provider community, our own and from various other sources as well, and the physician leadership organizations. I think we have to get beyond-- there are plenty of ways to point fingers and ascribe blame. I think we have to get beyond that. I think we have a fairly good idea of what the problem is. You just did a nice job of summarizing it. Interestingly, one of the studies that we discussed at that conference was a study done by some Stanford faculty, some UC San Diego faculty, that looked at implementations of the same electronic health record system, so the same vendor, in different environments. Here in California, in Australia, and Singapore, same vendor, the interface looks completely different. And the notes in Australia and Singapore, where there's a different payment model than in the US, were significantly shorter and failed to have a lot more decision making content than the notes here. In other words, there are problems, I think, with the architecture of the EHR. I think that will come up in the panel today. The systems that are out there today or based upon legacy stacks that are difficult to modify, and their problems with billing documentation requirements, and other things like that. I'm really pleased that CMS has taken this on and has proposed some revisions to billing documentation requirements, that I think offer opportunity in that regard. They're in the comment period now, I believe. But getting toward solutions is going to be really important. There's plenty of blame to go around and we all share in it, and now we have to focus on the solutions. But Jaewon, or Frida, or Toby, comments? JAEWON RYU: I guess the only thing I would add is, I think it gets to that curation concept. I think there's been a lot of investment in the EMRs and wealth of data, but making it actionable and that curating isn't there yet. I totally agree. But I do think that the activity along those lines is picking up. Simply because the current system isn't sustainable with all this information and very difficult ways to try to tap into it, whether it's decision support or analytics or otherwise. So I feel optimistic there. [MUSIC PLAYING] 

Healthcare leaders explain how the right data can move the needle.

Insights: The Ongoing Shortcomings of Electronic Health Records

Improving Electronic Health Records

Ongoing Shortcomings of Electronic Health Records

The Ongoing Shortcomings of Electronic Health Records

[MUSIC PLAYING] CLIFTON LEAF: What Apple was able to do with its electronic health records interface, very, very quickly, how does that change the game for EHRs and the rest of medicine? DR. LLOYD MINOR: We have a long way to go with EHRs. I mean, we still transmit records by fax machines in health care today. Can you believe that? I mean-- CLIFTON LEAF: Where are the fax machines? DR. LLOYD MINOR: Under the computer do you see a fax machine. I think what Apple has done in terms of empowering people to have their medical records on their device and in partnership with health care delivery systems like Stanford Medicine, that's very empowering for all of us. And it's a start, but we still have a long way to go to really make electronic health records interoperable, to make them serve the needs of our patients and of health care providers. The commonly used electronic health record systems in the country today are legacy systems based upon 1970s architecture, and they just don't lend themselves to the type of modern software innovation that Apple and other major tech firms are [INAUDIBLE]. And I do think we're starting to see change. And I think with the Office of the National Coordinator and a lot of other governmental agencies interested in this interoperability topic, yesterday, Dr. Seema Verma on Fortune Brainstorm Health, talked a lot about that in her remarks. And I'm optimistic that we're going to continue to drive that change and it can't come quickly enough. CLIFTON LEAF: So Sumbul, I look to bring you into this conversation about UX, right? And I mean this is, you know, Apple is famous for its user interface. It's famous for its consumer-centrism, and its looking at the health care world through these lenses. And tell me how that translates into, as you're thinking about projects to develop. DR. SUMBUL DESAI: You know, with what we did, for example, with the ECG app, it's something we're really proud of as a team is that that is an incredibly beautiful experience, but also an accurate and validated one. And so, when we think about the work, we really think about bringing those worlds together. And in every aspect of the development we do around health features, we think about usability at every step of the process, even with our studies, but also we think about the science along the way. So I think it's what's nice is we-- it's really special and amazing. And that's why it's so fun is you get to bring those two worlds together and hopefully develop really meaningful and impactful features for our customers. [MUSIC PLAYING]

Apple and Stanford University School of Medicine have worked closely toward discovery of how technology innovation can usher in a new era of proactive healthcare and Electronic Health Records. 

Insights: Apple and Stanford Medicine Partner To Make Electronic Health Records Interoperable

Technology can create ew era of Electronic Health Records

Apple and Stanford of Medicine on Electronic Health Records

Apple and Stanford University School of Medicine have worked closely toward discovery of how technology innovation can usher in a new era of proactive healthcare and Electronic Health Records.

Insights: Electronic Health Records

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Insights: The Ongoing Shortcomings of Electronic Health Records

Insights: Apple and Stanford Medicine Partner To Make Electronic Health Records Interoperable