By Lloyd Marino
It has been almost 6 years since the passage of the Affordable Care Act. legislation provided $30 billion in incentives for doctors and hospitals to digitize patient records. The healthcare industry responded and while 9.4% of hospitals in the US had Electronic Health Records (EHR) in place in 2008, now over 75% of hospitals in the US utilize EHR.
There are seemingly obvious benefits to EHR. Any electronic system is going to take reams and reams of paper and transform it into digital form. While costly to put in place, these systems not only organize data, they can also control costs by avoiding duplication of procedures and tests which has historically been a major cost drain on the healthcare system. Easy transfer and portability of information is a timesaver, increasing efficiency and therefore costs. No more faxing, photocopying, and overnighting of information, x-rays, and the like. A Wall Street Journal article pointed out that “studies show that 400,000 Americans die every year because of medical errors, including 80,000 because doctors don’t have in hand the information they need.” Clearly, well-designed EHR systems and software can not only save money and increase efficiency, they can save lives.
Yet, in 2014 the American Medical Association pointed out that over 43% of physicians thought that EHR software actually made their jobs more difficult. Even more problematic, as a Mother Jones article pointed out, “less than 10% of hospitals report they can trade records entirely digitally” The key problem, it seems, is a failure of interoperability. The various systems that have been created in response to the drive to digitize medical records don’t communicate with each other. There are eerie and ominous parallels to the dawn of the PC age when the operating system wars made consumers have to choose a system which might be (and often was) out of date and out of the market in months. (For example, IBM, Apple, Epson, and Osborne all had different OS–Epson ultimately dropped computer manufacturing and focused on printers and Osborne went out of business–and now IBM and Microsoft systems can “talk” to each other). However, this isn’t just about market share or corporate dominance, this is about people’s lives and health.
A related problem is the drive by healthcare to go “big.” The same Mother Jones article argued that the biggest player in the EHR market, EPIC, designed its EHR software so that it’s more about generating income than generating information. The author argued that the resultant lack of interoperability with non-EPIC systems was done on purpose as a form of “information blocking” designed to “enhance market dominance.”
However, big isn’t always bad. Kaiser Permanente has set up portals where patients can access their data electronically–they can even set up appointments, leave messages for their doctors, and order prescriptions. Geisinger Health System (which merged with NJ hospital system giant Atlantic Healthcare) is cited as a model of the use of data-driven healthcare, providing low-cost, high-quality care. As the Wall Street Journal reported, “Geisinger Health System, whose decades of investment in technology and integration have made it a pioneer in the use of electronic medical records and other data, dominates most of the rural markets it serves. The system focuses to an unusual degree on avoiding unnecessary procedures, in part because it also runs an insurance company that covers many of its patients.”
Geisinger claims that its approach is scalable and could be utilized in any and all markets across the country. And the claim is a valid one, as the company enjoys an enviable record of using data to dramatically reduce emergency room visits while also reducing readmission rates.
It seems that the best approach of all is for individuals to take charge of their own health records. After all, who cares more about you and your well-being than you? The federal government has initiated its Blue Button program–through which half of all Americans can access at least some of their electronic medical records. Private industry is also looking to help individuals take charge. A good example is Microsoft’s HealthVault App. There are many other examples of apps and wearable devices which allow individuals to carry their EHRs with them wherever they are. As individuals begin to take charge of their own information there will certainly be an even greater proliferation of apps and devices to accommodate it.
The evolution of Electronic Health Records has only just begun.
Image By: Wesley Wilson