Doctors and patients alike whine about the computers in the exam rooms. I tell students it won’t matter how you keep your records – if they could prove to me they could manage all of the gaps in care via a paper record. The truth is, as doctors got shoehorned away from taking excellent care of just the patient in front of them toward caring for the whole cohort of patients “assigned” to them, and the distribution of information became readily available so we could establish “best in practice” standards, the development of interoperability EHRs was foreseeable as being an essential part of that process.

So there is no going back. We need to quit whining. Adaptation for the new doctors is especially paramount. I know no one who can predict what will happen in health care in 2018. Most of today’s medical students won’t finish practicing until 2060.

Real-time clinical data is on the doorstep. With the release this week of a real-time glucose monitor, the very next step will be an artificial intelligence (AI) algorithm that will tell patient what the correct “best practice” response will be to any given outlying glucose. The medications to initially treat the top 5, then 10, medical conditions will all be OTC by the end of the decade.

That same scenario will happen for everything from blood pressure to cholesterol to uric acid, etc. within the decade. Then physicians will only have to manage the outliers that don’t respond to the first three (then five) “automated” real-time responses to changes. Oh, and synthesize all of the data that comes form all of the sources, including the time honored – why don’t we actually examine the patient and get a history concept.

The EHRs need to anticipate that patients will no longer come to the doctor for data in the near future. They’re going to be sending their providers not only hourly gigabits of personal data, but what their response to it has been. Physicians and the EHR vendors need to get ahead of that curve not lag a decade behind it.

Doctors need the financial tools to run their offices like the businesses they are. And they need to be recognized and compensated for the proactive work being done that identifies and prevents major illnesses long before the damage, often irreversible, is done.

One final comment – a prediction that I implied above ought to be taken with a grain of salt, — AI will change our world in ways most are not imagining. Let’s say I could get all of my uncontrolled diabetics to a normal HgA1c in 120d. How I go about that process is an algorithm. As such, it is programmable into a computer which will continuously learn and improve upon that process. It is the lack of real time data that is holding us back and that, my friends, will be here for 20 biometric parameters before 2020.

Happy New Year!

Theodore W. Shively, D.O

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