It’s 2015, which makes the fact that hospitals seem stuck in the past all the more odd. A world of high tech lab equipment is run by people who still regularly use pagers and fax machines.
Electronic health records – or EHR – could help healthcare providers move to the future (or at least the present).
First, a matter of definitions: there’s technically a different between EHRs and EMRs – electronic medical records. EMRs, by the Department of Health and Human Services’ Office of the National Coordinator for Health Information’s (ONC) definition, is "a digital version of the paper charts...the medical and treatment history of the patients in one practice." On the other hand, the ONC defines EHRs as having:
...focus on the total health of the patient—going beyond standard clinical data collected in the provider’s office and inclusive of a broader view on a patient’s care...They are built to share information with other health care providers, such as laboratories and specialists, so they contain information from all the clinicians involved in the patient’s care.
EHRs sound great, right? Your health information available no matter what doctor you go to! But the digitization of health records has been ongoing for a few years, and some people aren’t happy with the progress that’s being made.
Let’s get digital
So what reason do we have to upload our health records to the Matrix? The main objectives are to "cut waste, eliminate red tape and reduce the need to repeat expensive medical tests."
Cutting waste works in more than one way. First, it gets rid of a majority of paper files. That means less clutter and an easier time sorting, searching, and delivering records. It also – in theory – helps meet the other goals.
According to a MarketWatch study, redundant tests can cost $8 billion dollars per year. A person gets a test done with one healthcare provider and goes to another one – a different hospital, a specialist, etc – and has to get the same test again because the new doctor doesn’t have access to the data. It’s not only expensive in terms of money, but it also costs your time and, depending on how invasive the test is, it may not be something you want to go through again.
As far as eliminating red tape, it makes sense that a few clicks through a database is easier than having to call up another hospital, talk to someone, and wait for them to send the relevant records to your doctor.
All in all, it seems like a win-win-win situation: doctors have easier access to records, patients get results more quickly and easily, and the companies providing the systems make a pretty penny thanks to around $30 billion allocated during the 2008 bailout to help facilitate the process.
But this isn’t happening. Doctors can’t get access to records even when they’re digital. Fees make it expensive, different systems make it burdensome, and the whole process completely flies in the face of the goals that were supposed to help revolutionize healthcare.
But the companies managing the records are still getting paid.
What’s the holdup?
Truthfully, the issue isn’t making medical records digital. Many already are; as of 2014 over 75% of hospitals have a basic EHR system in place, up from around 9% before the Health Information Technology for Economic and Clinical Health Act – aka HITECH, obviously – went into effect in 2009.
The issues are what happens once the records are digitized.
One cause for concern is the wrong people seeing your records. We can only have Target (or Home Depot or T-Mobile or…) hacked so many times before we begin to prefer having our personal information chiseled into stone tablets rather than stored as 0s and 1s.
Looking at the Department of Health and Human Services’ "Breach Portal" doesn’t help things: there are almost 1,400 instances of breaches. (To be fair to computers, some of those breaches were of paper and film, so there’s that.)
But when it seems like anyone with a laptop can get into our personal data, that makes it all the more concerning when we can’t share that data with people we actually want to see it. Like, say, doctors.
Interoperability – the ability for the private companies digitizing records to be able to trade that information – wasn’t put at the forefront when HITECH was passed, and because of that the irony of the act’s name is becoming quickly apparent. One of the main goals of making this information digital, and one of the main selling points of the buzzword "cloud", is allowing access to information from anywhere. But companies have proprietary systems that can’t be accessed by hospitals who use a different provider.
It’s like buying an Xbox and then realizing the game you really want to play is only available on Playstation. Except the video game console is a company with the important data of hundreds of millions of Americans, and the game is your sensitive and necessary health records.
So why are companies doing this? Like a lot of things, it seems to be motivated primarily by money.
Take Epic Systems, the subject of a Mother Jones report. Epic Systems is the largest provider of EHR systems, managing the records of 56% of Americans. Their clients are some of the biggest names in healthcare: Kaiser Permanente, CVS, Johns Hopkins. They also made nearly $2 billion dollars in 2014. How? First, by setting up their systems with clients – Duke University paid a cool $700 million for their installation – and then charging to link different systems and charging again on a per-patient basis for hospitals to trade health information. Epic, along with other major healthcare digitization players, dropped "the fees it has been charging customers for data transfers between Epic customers and non-Epic customers" after accusations of information blocking. Being brought before Congress have a way of making people waive fees.
That’s not pocket change, and it’s incentive for companies to keep hospitals and patients locked into their ecosystem.
Epic isn’t the only one causing difficulty. Check out this report, by research firm KLAS and the College of Healthcare Information Management Executives, naming the weaknesses of the top ten EHR vendors:
"The company is perceived as inflexible and closed off"
"Sharing between clients could be stronger"
"Clients reported being irritated by costs and client-to-client sharing software"
"Weaker tools lead to lower level of sharing overall"
"Some clients report frustration with connections communications"
"There are significant challenges to sharing data"
"Frustratingly inattentive with interoperability projects at times"
In a system that was supposed to reduce cost and red tape, the damage is already being done. A 2014 study by the ONC showed that only 41% of hospitals regularly had necessary electronic patient information from outside sources.
Fortunately, there are steps being taken to combat information blocking. The Transparent Ratings on Usability and Security to Transform Information Technology Act (or TRUST IT Act, because acronyms) is looking to put punishments in place if medical information is being blocked when there isn’t a privacy or security reason for doing so.
How EHRs affect your life insurance
When you’re applying for life insurance, the process can take several weeks. One of the main speed bumps can be if the underwriter has to verify any medical information they received from your application or paramedical exam. This is usually in the form of an APS: an attending physician statement.
An APS is essentially your doctor’s summary of your medical history. If an underwriter flags something on your paramedical exam, they can use an APS to determine if it’s a medical condition or, for example, a temporary side effect of a medication.
If you see multiple doctors or a specialist, your health information might be all over the place. If you go back to the definition of electronic health records, they’re designed to be available to all of your clinicians. If that’s not the case – and, as we’ve seen, it often isn’t – it adds time and money to getting the necessary information.
In a perfect world, the digitization of our health records would be...well, perfect. The parties who need to see them would be able to, they’d be protected from outside breaches, and it would make healthcare easier, cheaper, and more efficient.
That’s not our reality, but that doesn’t mean it can’t be one day. It’s been less than a decade since the HITECH Act went into effect, and we might have been a little too optimistic about how quickly something as sprawling as healthcare can change.
But as efforts continue and positive steps – like removing sharing fees – are taken, there’s a good chance that digital health records move into the realm of reality.