The Evolution of EHRs and Observations with Dave Lareau

By Dr. Jay Anders, Chief Medical Officer, Medicomp Systems
Twitter: @MedicompSys
Twitter: @medicompdoc
Host of Tell Me Where IT Hurts – #TellMeWhereITHurts

In this episode I sat down with Dave Lareau, CEO of Medicomp Systems, for a discussion that includes Lareau’s observations about the evolution of EHRs and some of the biggest past and current challenges facing the industry.

But first, I share how David and I met more than 15 years ago. I was working for an EHR company that was evaluating Medicomp’s technology. That started a relationship that has “gone a lot of places,” including helping me to learn a good deal about informatics and EHR design and a personal friendship.

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Lareau, who has been with Medicomp for three decades, shares that he first started in health IT in the late 1980s when a surgeon asked for help with medical billing. Lareau, who was a CPA, became a reseller for a leading medical billing package, hired a strong team, and added several clients. Eventually one client––a private practice affiliated with Johns Hopkins––asked Lareau to help them find an EMR. After several months of demos with leading vendors, the doctors told Lareau that he was wasting their time––none of the EMRs did anything useful for them.

The doctors felt that the EMRs weren’t designed to work or think like a clinician, but instead made to help clinicians fill out forms for billing. In addition, finding useful information within the EMRs was difficult. It took Lareau another two years before he came across a solution that impressed the doctors. Peter Goltra, the founder of Medicomp, showed the Johns Hopkins physicians a technology that gave users all the relevant information for a clinical problem or diagnosis with just a single click. Lareau quickly realized that Medicomp’s technology was a game changer––and eventually joined the company.

Medicomp’s evolution

Over time, Medicomp transitioned from an EHR developer to a middleware vendor that helped EHR vendors solve their platforms’ usability challenges. By the late 1990s, Medicomp was focused on helping EHRs incorporate Medicomp’s clinical relevancy engine into clinician workflows so users could find the information they needed at the point of care. With Meaningful Use and other governmental and payer requirements for quality tracking and reporting, Medicomp’s tools became particularly valuable for clinician users.

The status of the industry

Noting that today we are in a ‘post-EHR’ world where virtually every provider has a system in place, I ask Lareau his view of the industry today. Lareau points to some of biggest challenges facing the industry, including burnout, systems not geared to value-based care models, and the ongoing need for better data––because today’s systems were designed for a fee-for-service, transactional-based world.

With the ONC’s recent publishing of the Trusted Exchange Framework and Common Agreement (TEFCA)that includes standards for how clinical data is transmitted, clinicians need to prepare for even more data because providers will be sharing more patient information. Unfortunately, clinicians already struggle to find information in their own systems – and will now need to figure out what to do with all the new “stuff” coming in.

Lareau and I agree that with TEFCA and the enforcement of the 21st Century Cures Act, clinicians are scared to death that they will now be responsible for all the new incoming data. With new interoperability requirements, users need to find a better way to sift through all the data to find clinically relevant information for a specific problem––without increasing clinician burnout. Interoperability will create huge technical and clinical challenges for the industry, especially as interdisciplinary care teams try to share data to improve outcomes and reduce the cost of care.

Noting that COVID-19 has changed everyone’s lives over the last two years and stretched healthcare in many ways, I ask Lareau how he thinks healthcare delivery will remain changed going forward. Lareau believes people are now more comfortable with telehealth and sees the industry relying more on interdisciplinary care teams that require greater patient involvement and more sharing of clinical information, especially since patients aren’t necessarily having a closed-door conversation with their doctor in the office. In addition, the concept of patient-centered medical records is becoming more widely accepted in the U.S., which is driving greater patient involvement in their own care.

The industry buzz

With the upcoming ViVE and HIMSS conferences, I ask Lareau what he anticipates the buzz will be this year and what Medicomp will be talking about. Part of the buzz, according to Lareau, is that TEFCA is making things real, and everyone realizes that providers need a better way to share data. Current EHRs are so bad that they have become an anchor to the delivery of care, rather than propelling things forward. Everyone is trying to figure out how to keep clinicians from having to deal with EHRs and right now many people are promoting the use of microphones in exam rooms to record conversations that miraculously turn into data––which Lareau believes is “magical thinking” rather than the practical application of technology to get better data that promotes better care.

At Medicomp, much of the focus has been on enabling clinical documentation improvements and clinical quality initiatives, plus a voice-to-data project that allows users to talk directly to the clinical data relevancy engine to find patient- and problem-specific data, filter the data automatically, then present it to the clinician. Medicomp is also working on tools for doctors, patients, and their caregivers to help patients be more engaged in their care. This may include asking patients to monitor signs of post-surgical infection based on certain prompts on their phone. Clinicians could then proactively encourage patients to seek immediate care when appropriate, rather than waiting until they end up in the emergency room. Lareau believes that providers are seeking ways to better manage outcomes and the cost of care, which requires tools that provide better data and engage patients and clinicians along the way.

Waving the health IT magic wand

I close with my signature question, “If you could fix one thing in healthcare, what would it be?”

“I would want to make sharing of data universal for anybody who treats a patient. I would want all barriers removed. I would want all blocking gone. I would want a standard for the secure exchange of that data and infrastructure in place so that the data could be trusted, found, and available. I see the path there. This might be the most exciting to be in our industry ever. It is the most challenging, but it is also the most exciting.”

This article was originally published on the Medicomp blog and is republished here with permission.

About the Show
On Tell Me Where IT Hurts, join host Dr. Jay Anders as he sits down with experts from across healthcare and technology to discuss ways to improve EHR usability for end users. Dr. Anders and his guests explore opportunities to enhance clinical systems to make them work better for clinicians, reduce burnout, maximize revenue potential, and drive better patient care outcomes. Join the conversation on Twitter at #TellMeWhereITHurts.