emRs hold great
potential for
clinical-decision
support by
translating practice
guidelines into
automated reminders
and actionable
recommendations.

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 straightforward task.

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.

 

Further Reading

Bates, D. and Gawande, A.

Improving safety with information technology. N Engl J Med 348, 25, June 19, 2003, 2526–34. Blumenthal, D. and Glaser, J. Information technology comes to medicine. N Engl J Med 356, 24, June 14, 2007, 2527–34.

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, 387–92.

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 technology writer.

© 2009 aCM 0001-0782/09/1100 $10.00

Biology
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 science.

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 genetic components.

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 harmful microbes.

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 and computing.