Notes on Engineering Health, March 2021: A Short History of the EMR

Jonathan Friedlander, PhD
Geoffrey W. Smith

Jonathan Friedlander, PhD & Geoffrey W. Smith

March 31, 2021

In the late 1960’s, the idea to record patient information in electronic form rather than on paper emerged. The goal of the first EMR, presented by Lawrence “Larry” Weed, was to allow a third party to independently verify a diagnosis in order to improve patient outcomes. The first EMR was developed in 1972 by the Regenstrief Institute and was welcomed as a major advancement in healthcare / medical practice.

Due to the high cost and scarce presence of computers, the adoption of the EMR was slow. It was still common in the early oughts to have someone run down to the records room and dig through hundreds of thousands of paper files to find a patient’s previous record—if the patient even had one—upon an admission. Logistically burdensome, prone to transcription errors, and incredibly inefficient, the paper-based system was kept in place until shockingly recently.

The first step to modernize medical records was to digitize them. In 2004, President George W. Bush signed an executive order designed to oversee the development of health information technology infrastructure that included adopting EMRs. In 2016, the government began an EMR implementation incentive program that offered benefits to providers that utilize these systems. The program’s success is undeniable. In a 2020 survey of national electronic health records, 89% of physicians reported using an EHR or EMR system. It is worth noting the difference between Electronic Medical Record (EMR) and Electronic Health Record (EHR). While the former is the digital version of the paper charts the clinicians used to work with, the EHR is a more comprehensive record of the patients’ health, going beyond standard clinical data collected by health providers.

The fast adoption of EMRs and EHRs by health systems did not come without challenges. It was accelerated when hospitals came to see the clear economic advantage of the electronic records. Indeed, EMRs were often implemented more as a billing tool useful to administrators than a solution to improve care for MDs and patients. As a consequence, in a 2020 survey of physicians by Deloitte, only 10% said they would leave their current EHR system unchanged. As far as EHRs are concerned, different studies have resulted in different findings, but one thing is fairly consistent: physicians hate them. Doctors resent the time spent on their computer entering data and keeping them away from interacting with and caring for their patients.

Both the promises and the challenges of the EHRs have created a myriad of opportunities for new companies—from retrieving and digitizing the data, structuring it, mining it with or without machine learning and artificial intelligence—as well as a series of perils mostly around security and biases. The wide adoption of EHRs has transformed the initial goal of getting a second opinion for a patient’s diagnosis to the opportunity to access and mine population-wide data for new medical insights—from N of 1 to N of many and back to N of 1. Regulatory agencies have started to measure the importance of this trend and the work of Amy Abernethy as the agency’s Principal Deputy Commissioner and acting Chief Information Officer for the past two years (she is leaving the FDA next month) is a testament to how vast amounts of data will shape and reshape the healthcare industry.

Jonathan Friedlander, PhD & Geoffrey W. Smith

First Five
First Five is our list of essential media for the month which spans a range of content including scientific papers, books, podcasts, and video. For our full list of interesting media in health and science, updated regularly, follow us on Twitter or Instagram.

1/ Our Animal Friends
A group in Sweden has published a new dog reference genome that has 55-fold better coverage than the prior reference genome. The paper notes that “domestic dogs have lived alongside humans for at least 10,000 years, and during this time, they have adapted to a shared environment and diet, while being selectively bred for traits such as morphology and behaviour. Humans and dogs also share orthologous genes, genomic architecture and disease sets, placing the dog as an important comparative species for human genetics and genomics. Taking advantage of pet dog medical records, within breed homogeneity and disease risk enrichment, it has been possible to provide insights into both rare and common spontaneous disease.” So our best animal friends are not just our companions, but helping us to understand who we are and how we can stay healthy.

Access to a closer animal neighbor to humans is proving to be an issue for developing vaccines to protect us from future pandemics. Once again illustrating the importance of our relationship to other members of the animal kingdom.

2/ Fantastic Voyage
Those of us of a certain age will recall a film called Fantastic Voyage that was premised on a technology that allowed people to be shrunk to microscopic size and then sent into the body of an injured scientist to repair his damaged brain. Turns out that science fact is catching up to science fiction at a company called Bionaut Labs.

3/ More Science Fiction / Science Fact
Another familiar trope in the science fiction/fantasy realm are zombies. Recently published research finds that gene expression in some brains cells actually increases after death. Which is both weird and a bit zombie-like. Of practical significance is making sure to take into account these post-mortem changes to ensure that researchers are interpreting findings on human brain tissues accurately which could impact our understanding of disorders such as autism, schizophrenia and Alzheimer's disease.

4/ Gut Science
Lots of interesting things going on in our guts these days:
– A Cell paper from researchers at NIH reports that the body's natural defenses against bacterial infection are helped by a nutrient—taurine—that causes the gut to recall prior infections and kill invading bacteria.
– A study in Science Advances shows how gut bacteria could be directly and indirectly affecting brain disease such as Parkinson’s.
– Another Cell paper reports that common gut fungi teach the immune system how to respond to their more dangerous relatives. Things don’t go so well if this process fails for any reason.
– And finally, one more paper from Cell, proteomics analysis indicated that intermittent fasting may not be a good way to lose belly far, but it still may be good for you.

5/ How Old Are You Really?
All though we all count our age the same way using chronological age, our biological ages do not necessarily perfectly correlate with this method. Researchers in Germany have developed a a transcriptome-based aging clock  that predicts biological age with an accuracy that is close to the theoretical limit. This age clock could find wide application in genetic, nutritional, environmental, and therapeutic interventions in the aging process. And is just another example of the amazing research happening widely around the world.

Digitalis Commons
Public-Interest Technologies for Better Health

Digitalis Commons is a non-profit that partners with groups and individuals striving to address complex health problems by building public-interest technology solutions that are frontier-advancing, open-access, and scalable.

Digitalis Commons continues to support Columbia University’s Program for Diversity and Inclusion in Commercialization and Entrepreneurship (DICE). The program offers among other efforts the possibility to meet with experienced life science entrepreneurs, industry executives, and venture capitalists through fireside chats, breakfasts, and lunch breaks. As part of this effort Digitalis’ Jonathan Friedlander is holding office hours every Monday during the length of the program to share his experience in VC and entrepreneurship and help participants navigate through the transition from the laboratory to the industry.

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