Why we cannot get there from here!


Our best wishes during this season of Thanksgiving to all of our students, faculty, colleagues, and followers. I myself am in a right handed cast following wrist arthroscopy for SLAC (scaphoid lunate advanced collapse). More on SLAC at a later date. Today the urgent topic is why we cannot get there from here!

I am speaking about the collective challenge that all health care providers face as we cope with the data requirements of health reform. By now, most providers are well versed in speaking the language of Cerner, Epic, Allscripts, and the like. Can you speak the language of reform? This is the key question on my mind.

The language of reform says, in my view, that you will need a registry to evaluate the population of patients for whom you are responsible. A provider must be able to come into the office, switch on the computer, and nearly effortlessly assess his own performance relative to a peer group as it relates to a population of patients. For example: In my own primary care practice, I should be able to instantly get good data on the patients I care for who share a certain diagnosis. I should be able to quickly assess my performance and learn new ways how I might improve. I should be able to do this with a minimum of fuss! There is just no way in my mind’s eye that I can envision the Cerners, Epics, and Allscripts of the world to be able to carry out this function.

We need a new generation of software to sit on top of these classic software boxes. The current EMR is really an electronic chart, not a tool for improvement at any level. I am intrigued then by the work of Anvita, Anceta, Phytel, Sandlot, NetOrange, Quantumleap, Humedica, Vree and others… can they get us where we really need to go?

I am interested in learning from our colleagues – will the current tools get us where we have to go? If the answer is no, as I contend it is, then what does the road ahead really look like as we build the analytic engine necessary for reform?


  • November 29, 2012


    The issues go far beyond software solutions. Perhaps primary care physicians should get paid for taking care of populations rather than the present system of getting paid for piecemeal work. I myself am “retired” from family medicine at age 54, having grown tired of being paid like a migrant farm worker. The present system of electronic health records, which I’m well familiar with having been through four major records were designed from the ground up for billing predominantly rather than patient care. The dirty little secret of electronic health records if used properly is that they decrease piecemeal work and actually decrease the need to see many patients in the office. This is a logical and great thing if you’re getting paid to take care of populations but not so great if you are still being paid in a piecemeal manner. I found myself in a hospital system at the short end of this stick.


    Louis E.Spikol M.D.
    Jefferson Medical College 1984

  • Danielle Casher
    December 3, 2012

    While I agree with Dr. Nash that many EMRs run the risk of being merely more legible modes of documentation, we have, in my setting, used it to incorporate improvements in care. For example, we can modify our “pop ups” to help us “not forget the stupid stuff (as Dr. Gawande says). We have added “did you do an HIV test” reminder for every time we order other STI testing. This has resulted in higher rates of HIV testing and better adherence to the CDC recommendations to test all adolescents.

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