emRs hold great
tant piece of information in the midst
of juggling several other urgent tasks.
Saleem’s work is complicated by
the fact that the practice of medicine
is highly individualized. Indeed, physicians in the same specialty often work
differently even when performing the
same medical procedure. Here standardization and flexibility must also be
balanced. Too much standardization,
and clinicians chafe under rules that
don’t match their own work habits.
Too little, and workflow becomes less
efficient. EMRs hold great potential for
clinical-decision support, for example,
by translating practice guidelines into
automated reminders and actionable
recommendations. Yet as Partners
HealthCare CIO John Glaser explains,
“You want to guide [clinicians] rather
than getting in the way.” And striking
the appropriate balance isn’t always a
Technology, however, is only part
of that equation. “It’s really a much
larger question that gets back to how
we train our doctors,” says Bero. Is
medicine more art or science? Is good
judgment more important than a rigid adherence to medical consensus?
Though most people would agree that
some variation in care is appropriate,
the flexibility of EMR-encoded workflow depends on how you answer those
questions. Economic incentives may
also make a difference. Pay clinicians
per procedure, as the U.S. health-care
system typically does, and you give
them little incentive to make workflow
more streamlined or efficient.
As the U.S. debates these issues,
the rest of the world is moving forward with its own initiatives. In Europe, EMR adoption rates are at 50%
or higher in most countries, though
as Middleton points out, that may
be about more than just technology.
“Where there are nationalized, centralized healthcare systems, there
have typically been large investments
in health IT,” he says. The European
Union is now trying to implement
EMR standards that would enable
country-to-country data exchange.
Meanwhile, thanks to a combination of frugal entrepreneurship and a
more liberal approach to regulations,
countries like India and Thailand have
in many ways surpassed their rich-world counterparts when it comes
to health IT. Several Indian hospital
chains use locally built EMRs, as does
Bumrungrad hospital in Bangkok. And
the rich world is beginning to take note.
Apollo Health Street, an offshoot of India’s Apollo Hospitals Group, sells HIT
software to American hospitals, while
Microsoft purchased software, intellectual property, and other assets from the
Bangkok-based company that developed Bumrungrad’s systems in 2007.
Bates, D. and Gawande, A.
Improving safety with information
technology. N Engl J Med 348,
25, June 19,
Blumenthal, D. and Glaser, J.
Information technology comes to medicine.
N Engl J Med 356, 24, June 14, 2007,
Hillestad, R., Bigelow, J., Bower, A., Girosi, F.,
Meili, R., Scoville, R., Taylor, R.
Can Electronic Medical Record Systems
Transform health Care? Potential health
Benefits, Savings, and Costs. Health Affairs
24, 5, 2005, 1103–1117.
Sittig, D.F., Wright, A., Osheroff, J.A., Middleton,
B., Teich, J. M., Ash, J. S., Campbell, E., Bates, D. W.
Grand challenges in clinical decision
support. J Biomed Inform 41,
2, April 2008,
Stead, W. and Lin, H.
Computational Technology for Effective
Health Care: Immediate Steps and Strategic
Directions. The National Academies Press,
Washington, D.C., 2009.
Leah hoffmann is a brooklyn-based science and
© 2009 aCM 0001-0782/09/1100 $10.00
Treating Human Disease
Peer Bork, a bioinformatician
from the european Molecular
Biology Laboratory in heidelberg,
germany, has won the royal
society and académie des
sciences Microsoft award, one of
the largest international prizes in
Bork won the €250,000 award,
funded by Microsoft research,
for his work that focuses on
discovering the important
relations between the nature of
the human microbiome—the
union of all microorganisms that
live in and around the human
body—and various parameters
such as age, ethnic background,
nutrition habits, and individual
due to improvements in
technology, researchers are able
to capture genomic information
from microbes in tiny samples,
such as pieces of skin. This has
translated into an enormous
amount of digital data stored
in different databases, and
Bork will use computational
analysis to make sense of this
vast amount of information
and begin to draw relationships
between the different sets.
For example, when examining
samples from humans with
diarrhea, which causes one-fifth of child deaths worldwide,
researchers might be able to find
the species of microbe, which
causes this disease. They hope to
then develop an understanding
of how to prevent or quickly
treat it, perhaps with a yogurt
containing other bacteria
that can selectively reduce the
Bork’s earlier research uses
computational analysis to mine
lists of unwanted side effects of
any given drug for information
that could help with possible new
uses for the medication.
The royal society and
académie des sciences
Microsoft award was established
to recognize outstanding
contributions to science made
by scientists working at the
intersection of science and
computing. The 2009 award was
open to scientists working in
europe at the interface of the
physical or biological sciences