Version 2 of EMR/EHR. I don't see it coming with what we have now. I'll bet you use a much more skookum EHR than my wife does. She uses one written for midwives. But then, she also does naturopathic medicine and that one requires a different set of fields so she uses two. And when a patient graduates from prenatal care to naturopathic care, the intake has to be done all over again. Both of them will allow you to dive through their data, but it's GIGO - if you call something "depression" with one patient and "sadness" with another, you get a report for "sadness" and "depression" each with an n of 1. This is something that came up with the discovery of the opioid epidemic - there was no agreed-upon standard of what you call an opioid overdose so they got reported under 20 different categories in Ohio alone. Once a researcher went through and screened everything that could be an opioid overdose and went back and looked at the autopsies and death certificates, they saw this: ...but they didn't see it until 2013. Metadata is a bitch. I have to plumb my own for Soundminer and every library uses their own tags. I ran into this when I was looking into stock: Getty and Corbis both use different tags. ICD10 standardizes the diagnosis for billing, insurance and statistical purposes but it doesn't standardize the history. I think you're right - there will be a push to make the terminology standardized so that it is more easily parse-able. But it's going to be the kind of herculean effort similar to the 12 years it took for homosexuality to cease to be a mental disorder between the DSM3 and DSM4.
Beyond that though. Not just V2.0 of the EMR systems, but V2.0 of how we think about medical data. Yes, your personal data is your personal data AND each individual represents data points that are relevant research/epidemiological data for their age/sex/smoking class/alcohol class/ etc ad infinitum. I think the bigger part of the revolution is going to be in the legal aspects of how that population level data is accessed/who is allowed to access it. With the example you listed about 'sadness' and 'depression' I think a sufficiently intelligent program like Watson would be able to parse all of that into meaningful 'buckets' like that researcher in Ohio, but at lightning speed and can report results in such a way that individual patients are protected. As part of one of my current protocols, when a patient gets admitted to the hospital, I have to generate a 'shadow chart' that details each days testing, how much IV fluid and what kind the patient gets, how much and what exactly they eat, med lists, etc. I'm basically making an anonymized copy of the main medical record for their admission. Watson could do the exact same thing en-masse if we gave it the permissions and guidance to do so. Then, with (God I hate using this word) standardized, anonymous description of clinical courses of diseases, we could then turn our super-doc program loose on those reports to extract statistically meaningful data both about disease and about the efficacy of contemporary treatments. I agree that I don't see it happening with what we have now. But I think that what we have now unsustainable. Research institutions are scrambling to find a model that really WORKS and they are trying to maintain the facade that they know what they are doing, which, from my observations, they don't. The high-level decision making positions are filled with geriatrics who at best don't understand the potential value that ML can bring, and at worst, are openly hostile to automation and technological advancement. There are old docs who maintain the mental and philosophical flexibility to be open to radical, systemic change, but it's not common.Version 2 of EMR/EHR.
the current system is sustained by government cash injections in the form of rewards for required compliance levels emrs are damn expensive as you presumably know. one of the myriad factors in cost disease, but one that gets forgotten for some reason. still, one of the most necessary
It's so much better than what we had, though, d00d. My wife requested her records from the hospital she went as a child. 240 pages of hand-written notes. No correlation in any of it. You see "unsustainable" because you didn't see the great leap forward.
I was a sick lil baby, now sick grown ass man. When 'The Great Leap Forward' happened, my 'chart' that was commonly trotted out was over 2000 pages, mostly front and back. I understand that where we are now is leaps and bounds ahead of what was, but it's still grossly lacking in what's possible. You don't organize digital files the way you organize paper files, and right now, broadly speaking, we have digital data being organized and squirreled away like paper. We are capable of much much more.It's so much better than what we had, though, d00d.