In the old days — and unfortunately in many cases in the present day — the world of patient health records was typified by the dreaded clipboard at the front desk, and the seemingly endless (and repetitive) intake forms which one has to fill out when you travel from a primary-care provider to a specialist, from the specialist to a lab or imaging center, and yet another set of forms when you are finally treated at a clinic or hospital.
The thought was: Why couldn’t all that data be collected one time and stored electronically somewhere, so the patient wouldn’t have to repeat it each time they sought medical care? Why couldn’t a physician's office or medical clinic obtain all the history from previous medical encounters, and not re-enter it into their own medical records systems?
This was the thinking literally decades ago, when virtually all industries were beginning to embrace technologies to automate and streamline work flow, give access to necessary information to all stakeholders within the work flow stream, and to eliminate errors of handwriting and the many threats of loss due to paper records from fire, flood, or theft.
The promise of digital health in general, and EHRs in particular, was to eliminate all this record duplication and waste, with its concomitant errors and omissions.
Fast forward about 30 years, and we have the ARRA/HITECH act, which threw literally tens of billions of dollars towards healthcare IT adoption. We have hundreds of EHR systems, and we have thousands of ancillary digital health systems and subsystems.
But in reality, most of these systems still don’t “talk” to each other. If you go to your primary-care physician, he has digital system "X" for practice management and scheduling, and perhaps system "Y" for billing, coding, and insurance payments, and system "Z" for clinical functions like labs, prescriptions, and clinical encounters. (In fact you are fortunate if your primary-care physician even has these systems, because the rate of penetration and adoption among primary care is still well below 50 percent in actual practice.)
When you go from your primary-care physician to a specialist, you are more likely to encounter more automation, and a completely different version of systems "X," "Y," and "Z" (almost makes me think of The Cat in the Hat). But there is very limited interconnectivity and interoperability between and among different providers, clinics and acute care facilities, and their different electronic records systems. Even if a given provider has up-to-date electronic patient healthcare systems, it is unlikely that he/she can transfer that information to another provider or clinic across a different episode of care.
So in many cases the electronic record — or a subset of that record — is printed off or faxed from one provider or clinic to another. And even within a clinic, many times there is limited sharing of data seamlessly between/among systems.
Part of this issue is technical. Systems have been developed by different companies and with different designs, so many times it is necessary for interface systems to allow for data sharing. Many technical standards have been developed to enable this data sharing, and this has led to significant progress in improving interoperability and data sharing.
And much work needs to be done to continue to improve technology systems — including software as well as user devices — to make it more functional for clinicians and other healthcare professionals.
But part of this issue is not technical, it is operational. A lot of this inefficiency is a function of history and inertia. If you look at the recent hiring trends — which have held fairly steady for at least the last decade — one of the greatest growth sectors has been in healthcare. And the vast majority of those new hire positions are not clinical, they are administrative. Or, as a CEO of a large integrated physician network stated at a healthcare forum our company recently hosted: “One person’s waste is another person’s paycheck.”
One irony is that on the medical technology side — imaging, robotic surgery, implants, to name a few — there has been a veritable technology “arms race” to develop and implement the latest and greatest technology tools. The medical records side, on the other hand, has lagged terribly.
So much more work is needed. Merely digitizing the patient records, without allowing them to be easily shared within clinics and across boundaries of care, does not provide the full benefit of electronic healthcare systems. All parties — hardware and software technology designers, systems integrators and implementers, business office, and clinical staff — need to work together to maximize and realize the promise of improved healthcare using automation and digital systems.
All other industries — financial services, transportation, hospitality, manufacturing — have shown the way. Healthcare needs to follow suit.