- The IHE project is already working in defining software standards for EMR systems to improve information exchange. With added support from healthcare providers through financial incentives for implementing EMR and EMR interfaces, the movement away from the paper chart will gain speed.
- Wikis already exist for a multitude of Web2.0 applications, from the ubiquitous Wikipedia to the recent additions of German Wikis studying PhD theses of prominent politicians and scientists for plagiarism. A dedicated core team to build the Wki structure, supplemented by volunteers in good Web 2.0 tradition, will need to be funded to get the paradigm shift started. Cloud computing and Wiki software has brought hardware costs down significantly; funding for salary support of the core team needs to be raised by a combination of grant support, private donors, and through patient advocacy groups.
The third step, implementing EMR tools to analyze practice-based outcomes vs a national standard, and gathering data to define the national standard, is the most challenging aspect of this proposal. As healthcare providers and managers in the health care sector, we need to make the availability of patient outcome analysis tools within any EMR system a major criteria for driving purchasing decisions of EMR software. Customer demand will need to drive the industry agenda here. Gathering national standard data on a meaningful level and with significant volume to have statistically signifcant patient cohorts for analysis requires us to move away from the concept of clinical trials as the only way to create evidence-based medicine. Patient registries, casting a much finer net to collect more, and more relevant, data for database mining need to be developed.