Keep Your Crystal Ball – Un-predictions for 2019 – Volume 3

Written by: GLHC
Doug Dietzman

By Doug Dietzman, GLHC CEO

January 10, 2019

There is much uncertainty about what the future will bring for the health information technology industry. Doug Dietzman, Chief Executive Officer of Great Lakes Health Connect, an experienced professional and thought leader in the field, shares his thoughts on the current and future state of healthcare delivery and technology.

This is the first in a limited series of posts. Additional thoughts will be added through the end of January 2019. Find them on the GLHC blog, The Exchange!





The “Top 10” lists that are common this time of year always bemuse me. They all speculate on what will unfold in the year to come.

Those who create them are rarely held accountable for their predictions, but are still called “experts”. The lists all sound similar to each other and typically reflect the “shiny object” themes of the moment.

This is not one of those lists.

I have no interest in predicting what might happen in 2019 and glorifying technologies that are not ready for prime time. Instead, I want to offer practical thoughts and perspectives on what I think SHOULD happen in 2019 to advance health information technology and the healthcare industry generally.

This list will not be exhaustive, nor predictive.  It is meant to be practical and doable, while avoiding the “squirrels” that distract us from addressing the REAL challenges in healthcare.



See Volume 1: Interoperability HERE

See Volume 2: TEFCA HERE


Volume 3: EMR usability – Think Modular, Not Monolith

Broad adoption of Electronic Medical Records (EMR) systems is arguably the most significant technological advancement in health care in the 21st century. Despite this, EMRs may also be the greatest source of frustration, disdain, and disappointment in recent memory. There are several reasons why EMRs have not lived up to the lofty expectations of clinicians, legislators, bureaucrats and other healthcare stakeholders. Not the least of these is “Usability” – The ease with which a technology is satisfactorily adopted and integrated into regular workflow; and the degree to which it positively impacts operations. Usability will be an even bigger discussion topic in 2019 as the government “helps” define (and likely requires through certification) what that actually means to clinicians.

There is no doubt that EMRs have become an integral tool for clinical care. However, false doctrine that the EMR needs to do everything for everyone has hampered success. The prevailing wisdom in healthcare today is that the EMR should initiate, complete, and document anything and everything that happens in a hospital, physician office, or other clinical setting. We need to stop thinking of EMRs monolithically, and instead consider the specific functions that are needed modularly – separate, interchangeable, and optional interactive components.

At present, beyond elegantly supporting a physician’s interactions with patients, and documenting each encounter, the EMR is the central repository for EVERYTHING else too. Functionality to handle care management, referral management, billing and payment, insurance and eligibility, scheduling, social determinants, alert/event notifications, patient training and education, interoperability, electronic signatures and acknowledgments, patient communication and engagement, patient portal registry and risk stratification … and on and on it goes.

In addition, data collection requirements are added to the workflow that have nothing to do with documenting the physician’s encounter with their patient; but it’s data that the government, some researcher, or another external entity requires be captured and stored.

As if that were not enough, many EMR systems have a “one size fits all” approach, despite obvious differences between practices and organizational size. This is particularly apparent in recent years, as competition and consolidation has given way to a much smaller group of system vendors serving vastly larger shares of the healthcare industry. The information an oncologist needs in their EMR is different from what a primary care physician needs, is different from what a behavioral health provider needs, etc. for hundreds of different specialties; and what works for a small 2-physician practice is vastly different than what is necessary to manage a large, 100-physician, multispecialty practice.

Yet, with all this complexity, there is an expectation that the EMR be “usable” while the push continues to pack more and more data into a single monolithic platform. This simply is not working. Barring a radical change in expectation and approach, this will continue to be a problem in the future.

A significant factor in the persistence of this dynamic is the requirement that EMR systems satisfy an enormous number of regulatory requirements. To put it plainly, the government needs to get out of the business of defining what should or should not be in an EMR. The certification requirements mandated over the last decade are financially burdensome. They have driven EMR vendors into a “check the boxes” mindset. This focuses innovation on satisfying bureaucratic directives at the expense of clinical usability and patient engagement.

The practice of medicine is very complex. New business and clinical models create additional complexity.  If we want EMRs that are more usable in 2019, we need to focus on serving clinicians and patients. We need to think more modularly about how to support other functional needs in the organization. Sometimes those functions need to be integrated within the EMR, but in many cases, they do not.  As long as we continue to push for one monolithic solution that meets all needs in all settings for all specialties of all sizes, we will miss the mark.  If we believe we are moving to an API-based world, the monolithic EMR is not necessary and will be a significant hindrance.