Social networks, telemedicine will forever change the delivery of healthcare

John Squire, Amazing ChartsEditor’s Note: John Squire, president and chief operating officer of electronic health record (EHR) company Amazing Charts, spoke with Medical Economics about the present and future of health information technology. Here is the full interview. Excerpts of this interview were published in the October 25, 2013 issue as part of the publication’s Top 100 EHR company ranking.

Medical Economics: In what ways is technology transforming medicine?

Squire:  If you look at the history of medical care, this is the point in time when there’s more technology involved in the clinician’s life than ever before. I think a part of that has been driven by government incentives to adopt EHR/EMRs, or at least to get everybody out of the filing cabinets and into an electronic playing field. Once you’ve got a baseline of information captured in electronic format, then the question becomes, “Well, what can you do with that?” One of the things you can do with that, clearly, is to securely share it, exchange it, and have something that approaches a continuum of care between providers. And that’s driving health information exchange.

The second thing you get is a bunch of data, which can be analyzed for trends and other metrics.

The third thing I see is the new care models that are possible because you have this electronic infrastructure. Whether you call it a Patient-Centered Medical Home or accountable-care organization, basically the ability to manage patients between acute episodes, and avoid acute episodes to keep the cost of care down and the outcomes more favorable by more consistent monitoring.

There’s also a host of technologies reaching into the home. These technologies are giving physicians and patients a way to monitor these chronic conditions in a way that we never could before, and work that into a care plan that’s proactively administrated by a team versus a single clinician trying to keep up with a whole host of patients. 

Medical Economics: If you could think about the delivery of medicine in the next 5 years, how will it change? How important will technology be in helping to guide this evolution?

Squire:  The idea of electronic decision support at the point of care, I think is now possible. You’ve got enough of a base of data. Using analytics and other tools that clinicians can be advised on what is the best course of care for a given patient, against an overall patient population, or based on evidence-based protocols that have been derived from a larger population. Now is the time when electronic tools can be used to introduce that at the point-of-care, rather than after some period of study.

I think the catch-all is mobility. We live in a Facebook era.  How is this generation growing up surrounded by social media going to receive their care 5 years from now? How important will telemedicine become? 

How important will social networks become to gather information and get advice?

Also, our definition of clinician is going to change dramatically. If you look at the trends in primary care-the declining numbers of primary care physicians (PCPs), the increase in patient populations, the increase in insured lives under the Affordable Care Act-clearly, somebody has to be talking to, monitoring, and educating these patients. It cannot be a PCP in every case, and that’s why we are seeing the growth in different professions to help-physician assistants, nurse practitioners, and others.

The idea of going to see the guy in the white coat, face-to-face in his office is going to become less prevalent and the idea of getting advice and treatment from somebody on the other end of the line becomes more and more pragmatic.

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Medical Economics: We are 3 years into Meaningful Use. The government continues to incentivize and will ultimately penalize physicians for not adopting EHR systems. Why has it taken such a massive push to get physicians to adopt?

Squire:  The Centers for Medicare and Medicaid Services did a study on the adoption of technology and the correlation to clinician productivity. And in pretty much every other industry, technology adoption leads to increased productivity. In healthcare, technology adoption has actually lead to a decline in productivity. It’s a small decline, but a decline. If you talk to clinicians, they’ll tell you that very often they have to do their jobs twice. They have to do their job when they see the patient, and then again after the 
patient leaves to enter data into the
 system because it’s too cumbersome to do while the patient’s in the room. 

While there are other technologies that can be employed, such as voice recognition and dictation services and things like that, at the end of the day if the technology hurts productivity you’re going to get resistance to adopting it. 

Medical Economics: Interoperability takes on far greater importance with Meaningful Use 2 (MU2). Is the healthcare information technology sector ready?

Squire: If you look at what’s in MU2 and MU3, it's still at the level of what I would call plumbing. There's a basic set of information that gets transmitted from point A to point B that can support a continuum of care. It's much different than facilitating collaboration between clinicians. That would allow a primary care physician and specialist to look at the same lab report, for example, at the same time to discuss it and come to a joint conclusion on the best course of care. 

I think MU2 and MU3 are there to impose some low-threshold measurement on the system.  But it should not be anybody's goal to just meet MU2 and MU3.  It's all the stuff that follows an encounter that really will distinguish what's a good technology, what's productive and what actually leads to improved outcomes. You can be perfectly compliant with MU2 and not have improved outcomes. 

Medical Economics: Will we see more consolidation? What happens in the health information technology (HIT) market when the government incentives to adopt EHRs run out?

Squire: If you look at what's happened in the industry over the past 5 years, there has already been considerable consolidation. It’s not just between EMR/EHR vendors, but acquisition of interoperability technology, of health information exchanges, of analytics companies, of portal companies.  A lot of that is not necessarily driven by MU2, but increased capital needs of supporting ongoing regulatory requirements, and that includes ICD-10.  Regulatory requirements are getting more and more stringent, and there are more and more of them. It will take a bigger and better funded company to meet these requirements. Yes, that will drive consolidation, and it has.

Medical Economics: What do you think will happen when the EHR incentives run out? 

Squire: We've kind of looked forward to them running out, because we were in this business long before the incentives came along. And we will be in this business long after the incentives are gone. It will come back to what it should be--a business decision.  Is this something that helps my practice?  Is this something that makes the practice more productive?  Is this something that helps me get paid faster?  If you can answer yes to those questions, then it's a worthwhile investment. 

Medical Economics: We live in a mobile world. How important is mobile technology to the future of medical delivery overall?

Squire: It's very important. I think we will be looking at a mobile world, going forward. I have already seen prototypes where you could have blood pressure monitors built into the steering wheel of your car. We will have the ability to transmit in real time back to a care center.

I think the great thing about mobile technologies is that they're always with you, and they can be equally helpful to a healthy and unhealthy population. Obviously, there are benefits for home care, visiting nurses, monitoring patients that are unattended. There are benefits to family interaction.  There are psychological benefits to mobile technology that people can feel connected and feel like they are being looked after. I think that the healthy population also benefits from wellness sites and those trying to engender healthy behaviors. People use mobile as a primary platform these days, not as a secondary platform. 

Medical Economics: What do you think HIT vendors will be talking about in 5 years as it relates to technology platforms/applications?

Squire: I think you're going to see a progression of some of these same topics but the technology will be far more advanced.  I think the notion of telehealth will just merge into being an accepted part of healthcare delivery. I think the notion of analytics will be well proven out. I think the reticence about cloud adoption will be overcome.  There will be less of a concern about privacy and security breaches, just like in online banking, because the technology will have improved to ease that threat.

I think the administration of care that we talked about earlier will continue to become more granular and more technology centered. I think HIT vendors will be talking about not just the technology but treatment the technology enables.

John Squire is president and chief operating officer for Amazing Charts. Most recently, Squire was senior director of Alliances and Cloud Strategy for Microsoft’s U.S. Health and Life Sciences Business Unit. At Microsoft, Squire was responsible for the partner ecosystem, including all major EHR/EMR solutions and systems integrators. Squire has previous experience in management roles at IBM, Dassault Systems, Formation Systems, and Interleaf. He holds a bachelor’s degree in physics and computer science from Ursinus College and an MBA from Harvard University.

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