Technology has an important role to play in improving a clinician’s efficiency, effectiveness and quality when providing patient care. In recent years however, undue time, effort and investment has been focused on a single system of record – the Electronic Medical Record (EMR) – at the cost of other important technologies that can complement this investment. The electronic medical record is important; however simply digitising the medical record has limited the return on investment from other transformational clinical initiatives. What we really need is an investment in the core capabilities, integral to clinical care processes. Capabilities like:

• Communication: How can care providers connect in real time, one to one or one to many. 
• Collaboration: Technologies to support virtual teaming on documents or initiatives, knowledge portals of information and clinical evidence, and the ability to connect and share information with relevant third-party organisations.
• Measurement: Technologies that allow analysis and insights from data captured in the care process, for clinical outcomes, benchmarking, clinical process improvement, performance management and predictive analytics.
• Mobility: Technologies that support the clinical workflow across various devices at the point of care, and are also appropriate to the clinical role and venue of care, including smart phones, tablets, laptops and computers on wheels.

 
The previous generation of EMR thinking leveraged the HIMSS EMR Adoption Model, which has led to prescriptive thinking around a 10 year, $1bn journey to a highly automated outcome, with an association to clinical performance improvement. However, this journey has significant inherent risk and change management overheads that can compromise clinical adoption and anticipated benefits. It has created an industry of proprietary EMR systems that interoperate or integrate poorly, and defer higher value functions like medications management and clinical documentation toward the end of the adoption journey.

The current pattern of clinical transformation leveraging IT, follows quite different principles. It favours a different type of company from the traditional, one size fits all, on premise model. These more innovative organisations; 

• Emphasise an intuitive user interface, which decreases the change management burden.
• They interoperate openly using modern, as well as legacy, interfacing standards, rather than create proprietary lock-in.
• They consider mobility in functional interface design, including touch and pen inputs.
• Implementation allows for minimum product thinking by the client so they can zero in on high priority workflows, even when these workflows involve processes like medications management.
• Creating additional product functionality is done via rapid cycle iterations with tight end-user feedback, in contrast to big-bang deployment of entire digital systems.

Most importantly, these next generation systems have learned from the limitations of the past, and integrate the robust, industry grade technologies that support capabilities like unified communications, enterprise content management, business intelligence and mobile computing. These are the systems that are optimised for the needs of our workforce today, with the openness and flexibility to adapt to the changing needs of tomorrow. 

• Are we MAD? Issue One
• Are we MAD? We're getting there! Issue Two