A Step Toward Digital Health Biographies

On October 3rd, Northwell Health and Allscripts announced a collaborative project designed to create the "electronic health record of tomorrow." The venture seeks to build an electronic health record (EHR) system that responds to voice commands.

While EHRs are a potentially valuable tool for health care and health maintenance, present-day versions are designed more for the benefit of insurers and payers than for doctors and patients. They arguably do more harm than good for the delivery of care by increasing providers’ administrative costs and detracting from quality of care by forcing providers to spend a great deal of time facing computer screens, rather than patients.

If a voice-command system proves less burdensome, it could positively impact both patients and providers and move the entire system closer to what Mercatus scholars Robert Graboyes and Darcy Bryan have called “digital health biographies” (DHBs)—unified, multisource records of an individual’s health and healthcare.

Northwell Health is New York's largest healthcare provider, and Allscripts is a leader in health information technology. Together, these two giants are working on merging artificial intelligence with today's EHRs to create a technologically advanced system. The goal is to create a platform that would be cloud-based and voice-enabled. The partnership’s plan is to deploy this system first across Northwell's network of 19 hospitals and 750 outpatient facilities across the state, working closely with providers to optimize the experience for physicians and patients.

This transition will not be cheap. EHR systems currently cost $33,000 to install per provider, with an additional $4,000 or so in annual maintenance costs. For all that expense, present-day EHRs are limited to a few capabilities such as collecting, storing, and reporting on healthcare data. Adding new technology may increase the initial upfront costs, though there may be offsetting benefits. Today every office-based physician, on average, requires two administrative support staff per physician. The voice-enabled system could potentially reduce or eliminate the need for this extra staff; the new systems could theoretically pay for themselves long-term (with emphasis on “theoretically”).

Medical data entry is a time-intensive process that tends to occupy half the time during a primary care visit. Patients and doctors alike complain that EHRs in their current state interrupt conversation and detract from overall rapport between the patient and physician. Many or most providers spend time outside of work to complete their charting. It should not come as a surprise that EHRs in their current form are frequently cited as a reason for retirement among practicing physicians. Voice-enabled systems could cut down on administrative burdens and promote a higher quality of care. 

Northwell Health's and Allscript's partnership is not the first instance of corporate giants entering into the EHR market. In November of 2018, Amazon announced it was developing its own version of the technology, a HIPAA-eligible service that would analyze patient information providing diagnoses, recommending treatments, and suggesting drug dosages.  

Experiments like these contribute to innovative advancements in this market and take steps toward moving from EHRs to DHBs.

For experiments like those attempted by Northwell/Allscripts and Amazon to be successful long-term, they first need to hurdle the Food and Drug Administration's (FDA) medical device approval process. A Forbes article by then-future FDA commissioner Scott Gottlieb explained that EHR companies are limiting the technology they may already have to avoid falling under the cumbersome review process. These innovative ventures can usher in the next generation of EHRs and move the needle closer to DHBs as long as bad policy and barriers to innovation don’t get in the way.

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