ATLANTA – The electronic medical record (EMR) is beginning to look a little bit like the weather. You know, that topic that everybody talks about but can't really do anything about.

Well, let's amend that saying a little bit.

There has been some recent progress in the adoption of EMRs by healthcare; however, those adoptions are coming mostly, and rather slowly, in the big hospitals and big physician practices, while rarely found – and when found, often under-used – in the broad range of small practices.

Thus, offering a sort of tea leaves-and-crystal ball look at this issue, presenters and panelists at a technology summit, sponsored here by the Technology Association of Georgia (TAG; Atlanta), outlined more obstacles than drivers for both EMRs and the development of integrated computer uses across healthcare in general.

Preparatory to a panel discussion on EMR systems, Barbara Archibold, head of global healthcare practice for IBM (Armonk, New York), indicated that healthcare should best use its crystal ball to look less at the future and more intensively at the past – "lessons we can take from various other industries to accelerate change" in healthcare's use of computer technology.

Change in the arena of integrated healthcare computer and data systems "has only begun," she said, resulting from what she termed a system "out of alignment" and the incentives for change "not well aligned."

The result, she said, is that the consumer is most often the one "stuck in the middle."

But polishing her own crystal ball approach, Archibold offered her views concerning the trends that she believes need to be pursued to achieve integrated electronic healthcare systems, from three perspectives: the payer, the provider and what she called the healthcare "ecosystem."

Payers, she said, must be much more closely attuned to consumers, given the variety of new choices and offerings, combined with more information about healthcare to create an "empowered consumer."

Archibold defined "consumer-driven healthcare" as meaning greater demands by patients for more services and more efficient services. She predicted, as just one example, that more people will be asking why they can't go online and register in advance for elective surgery or access other health services, thus modeling "many of the things from the retail or commercial perspective they can do."

The result, she said, is that payers "need to respond faster to this competitive situation." And Archibold asked, rhetorically: "From the healthcare perspective, shouldn't we be pushing some of this [healthcare] information to our consumers?"

That information, she added, ought to be pushed with more precise segmentation: "new moms, senior citizens, 40-year-olds sports-minded, dual-income-no-kids" (known as DINKs), who are all increasingly focused on wellness and improved lifestyle.

On the provider side, Archibold foresees the need for healthcare IT to put greater emphasis on detailing its benefits. "We need to do a better job of helping customers understand the value [of IT] to help them make the argument for expenditures that are necessary on the technology side."

While she noted that it is fairly easy to demonstrate, for instance, the quick return on investment of a new MRI system, it becomes much more difficult to show how IT produces results via reductions in medical errors, time and money savings and better clinical outcomes.

The strategy for doing this requires "a holistic perspective," she said, involving the reengineering of workflow processes. Archibold suggested that this means less emphasis on hoped-for assistance from tomorrow's technology but rather an examination of workflow processes and "taking the technology of today and using it to better advantage."

Here, she emphasized integration, noting that even in many academic medical centers, there is a lack of connection, even in the same building, between research and the treatment of patients. As she put it, research concerning specific diseases is often "on CDs in the back room and not related to clinical information."

Sharing of this information, she noted, would lead to "personalized medicine."

While for clinicians this term is being used to mean the discovery and development of the best matches between the right therapy and the right patient, Archibold used it more specifically to mean employing IT to identify and deliver that most useful therapy to the patient, rather than leaving the information on the shelf.

Healthcare in this, she said, has taken "only baby steps to where we can be."

The third perspective and trend Archibold offered was in looking at the healthcare IT "ecosystem . . . where all healthcare players come together – payers, providers, physicians, medical device makers, pharmaceuticals."

Noting recent efforts by the Department of Health and Human Services, healthcare IT czar David Brailer and statements by President George Bush to push "a strategic framework for action" on EMRs, she said the key issue here is not "a technological problem." Rather, she termed it "a standards problem – building communities and positioning the various organizations and getting them to agree on what's important."

This will require, she said, bringing together "what the health systems want in a central repository" and the looser control that physician might want over this information. Other questions will include "who owns and who pays" for these systems. "These are the kinds of things that we're going to be working with across various healthcare communities across the next several years."

And clinicians should be "at the core" of this effort, Archibold said, with healthcare IT systems and processes not something we "do to, but do with" them.

"With interoperability of existing technology and a community with common goals, we can take the EMR, prove its value within institutions and then extend that value across the community," she said.

Archibold's presentation, followed by breakout panels (on which MDD will provide further detail), was developed by TAG as one of various special programs for its members.

Next: Obstacles, mistakes in healthcare IT purchasing.