Problems with the launch of HealthCare.gov have temporarily drawn Congressional attention away from our problems with healthcare IT. But you can be certain that even though this subject is “out of sight,” it definitely is not “out of mind”—nor should it be.
Why? Because we have spent more than $16 billion—with much more to come—subsidizing the adoption of electronic medical record (EMR/EHR) systems by physicians and hospitals, more than $1.3 billion trying to develop a single EMR system to serve the DoD and VA, and hundreds of millions of dollars building health information exchanges — all seemingly for naught. As reported in an important study released last week by Frost & Sullivan:
“Two realities have emerged from widespread EHR deployment . . . available EHR systems lack interoperability and cannot communicate with one another, therefore failing to reach the goal of creating seamless, universal and secure access to health information. . . . patient, does not own his or her health information, as this data is stored within the IT protocols of the EHR system, proprietary to providers, hospitals and health systems.”
Thus, despite these expenditures and the huge disruptions these programs have caused, doctors and hospitals have little more information today about their patients at the point of care than they had before we started down this incredibly expensive path! And these expenditures don’t even include the billions doctors and hospitals have undoubtedly spent installing and learning to use these new systems.
Is it any wonder Congress is up in arms? If they weren’t, we should fire the whole lot of them! And this is not a political issue. I’m not aware of anyone in Congress who is happy with this situation.
So where did we go wrong? The simple answer is we’re on the wrong “mission.” We had a preconceived idea but apparently never clearly defined what we were trying to accomplish, considered how hard it might be to accomplish, or looked for simpler, easier ways to achieve our desired results.
We saw that our healthcare system ran on paper records, and concluded that was “bad.” And we apparently leapt to the conclusion that if we could get every care provider using electronic records, we could link them together with electronic networks and everyone would be able to exchange records—and that would be “good.” With the benefit of hindsight, this approach was wrong and destined to fail though its proponents continue to press ahead without conceding its shortcomings. In addition, it completely ignored the growing interest patients have in their medical records.
The truth is, provider charting systems, whether paper or electronic, aren’t designed to share or exchange records (though providers do fax copies to other providers when asked). They are designed for providers to use for their own purposes—to keep track of a patient’s health issues and treatments, to bill insurers and to defend against claims. And that’s what they do.
So what’s the solution?
First, let’s recognize the obvious. We’ve got it wrong! We’re pursuing the wrong mission. We’re not meeting the needs of either providers or patients.
Providers don’t—and need not—care how their patient’s other providers keep their records. What they want at the point of care is easy access to other providers’ records that will help them understand their patient’s health issues so they can provide better care. Period.
At the same time, patients increasingly want to control their records, know they are correct, participate in their care decisions and, most importantly, know they’ll be available when they need care.
How do we accomplish these? We start by redefining our mission. It should be two-fold:
• to ensure that any provider can easily and electronically access their patient’s complete record from all their providers at the point of care, anytime, anywhere
• to enable any patient to electronically access their records and participate in their care decisions
Second, we adopt a new approach, one we know can accomplish our redefined dual mission. There’s at least one simple, inexpensive approach that can do so, and it’s available today! It puts the patient, rather than the provider, at the center of the solution.
This approach does not replace providers’ record systems. It complements and lives alongside them, and works with all of them. It aggregates copies of a patient’s records—both paper and electronic—from all their providers, on an encrypted electronic device (containing an application to manage them) that the patient owns and carries with them all the time.
The records are stored as searchable pdf documents that you read in a browser. When the patient needs care, they simply give it to their doctor or other provider. The doctor examines the patient and, as needed, electronically sorts, searches for and reads the patient’s relevant records.
This simple, different approach gets a decidedly different result. It works—and benefits all parties!
It accomplishes our mission for providers. They can electronically access and search their patient’s complete record at the point of care, anytime, anywhere—so they avoid mistakes and unnecessary tests, provide better, coordinated care and presumably achieve better outcomes. And when a patient transitions from one provider to another, such as from PCP to specialist, hospital to acute-care facility, or DoD to VA, the patient’s records move with them and are immediately available to the new provider. Finally, the cost of care is lower, and there is no need to build or maintain expensive HIEs or patient identification systems.
At the same time, it accomplishes our mission for patients. They enjoy peace of mind that anytime, anywhere they need care, providers can access their complete record, and that their records are secure and private. They receive better care, presumably experience fewer adverse reactions, and have the information they need to participate intelligently in their care decisions.
What this different approach also means is that providers can “have their cake and eat it, too.” Each can adopt and use whatever patient charting system he or she wishes—their current one or a new one—without compromising the ability of other providers to access their records when treating a mutual patient.
Does this mean provider records need not be computerized? Not at all. Even though many providers find today’s EMR systems very hard to use, they should be encouraged to adopt whatever EMR system works well for them so they can electronically access their own patients’ records and enjoy the many other advantages EMRs provide.
In short, by redefining our healthcare IT mission and changing our approach, we can get the results we want, today and at considerably lower cost!