The Barriers To Sharing Digitial Medical Records Come From Hospitals Too

"Oh, dear wall.  Doth let me exchange this patient's medical record beyond your stones!"

“Oh, dear wall. Doth let me exchange this patient’s medical record beyond your stones!”

As you may have heard, the NY Times recently published an article lambasting EHR vendors (Epic in particular) for creating barriers to share patient medical records in a digital fashion (or EHR interoperability as those of us in the industry call it).  This is somewhat of an about-face for the Times on their opinion of the company given this rosey article they posted a couple years ago.  However, this is pretty in line with how opinions of customers of EHR vendors change months after they’ve bought their new shiny toy and realize the pitfalls of actually using it.  Nevertheless, the NYT insinuated pretty clearly that it was the EHR vendors that were creating these barriers.

“As a practicing ear, nose and throat specialist in Ahoskie, N.C., Dr. Raghuvir B. Gelot says that little has frustrated him more than the digital record system he installed a few years ago.

The problem: His system, made by one company, cannot share patient records with the local medical center, which uses a program made by another company.

The two companies are quick to deny responsibility, each blaming the other.

Regardless of who is at fault, doctors and hospital executives across the country say they are distressed that the expensive electronic health record systems they installed in the hopes of reducing costs and improving the coordination of patient care — a major goal of the Affordable Care Act — simply do not share information with competing systems.”

Then of course, while the doctors and hospital executives blame the EHR vendors, the EHR vendors (Well, Epic and Judy Faulkner in this case) turn around and blame the government.  Given the latest opinion polls of our Congress, I don’t think many will dispute this.

"Late again, Steve!" "Ugh, The Government, right?

“Late again, Steve!”
“Ugh, The Government, right?

Now there was an interesting slew of blog posts after this article came out about the technical details on how EHR interoperability occurs and perhaps that it’s more of a standardized content issue (it is), but let’s take a small step back here.   Aren’t Hopsitals somewhat to blame here too?  Don’t get me wrong, I have a good time critizing EHR vendors and I can send you a long list of things they need to work on if you’d like, but it’s surprising that know one has gone back to Adam Smith: Free Market Economics 101 and asked a simple question:

Who actually has incentive to exchange medical records?

Patients? Yes.  Doctors and other medical practitioners? Yes.  EHR Vendors? Nope, as the NYT article details.  Hospital Systems? Nope. Wait, what?

Hospital organizations are built around a feeder system model.  That means the flow of patients and their information always goes in a singular direction: Up the chain.  Patients are funneled from outlying clinics into the centralized hospital system.  Let’s remember that while plenty of lip service is paid to the idea, patients do not control their personal health information despite the fact that they technically, and only technically own it.  So while the NYT lambasts Epic for being a closed-wall institution, they should have pointed out that hospitals are too.

Despite the many things I feel were wrong with the approach, the HITECH Act’s Meaningful Use program was supposed to change all that.  Stage 1: Get healthcare providers collecting data electronically.  Stage 2: Refine what they are collecting and prepare them to send it other places.  Stage 3: Exchange data electronically everywhere.  [Champagne cork pop].  However, like most government programs, sight was lost of the overall goals of the program as people started nitpicking the details and the whole project is on the edge of derailment.

Getting back to Adam Smith, our elementary economics lessons teach us that in a free market, if a product does not meet the specifications of the consumers, they won’t buy it.  Theoretically, if all of these healthcare organizations were really concerned with exchanging health information, the EHR vendors would create that feature in their product or perhaps a new market would spring up to specifically serve that need.  Where there is a want, and assuming those that want can pay for it, there will be a way.

Over the years, I have been in countless executive-level conversations between EHR vendors and hospital organizations on both sides of the conversation. In all of these discussions, I have not had one that involved a hospital organization discussing the exchange of health information between different organizations with the exception of those centered around Meaningful Use.  There has been plenty of discussion of passing records up the chain from clinic to hospital (also related to Meaningful Use, but not the primary driver), but never of interoperability.  Now granted, I’m generally not working with academic hospitals, and I can see some research incentives there, but what incentive do most hospital organizations have in exchanging data between themselves and their competitors?  None.  Please show me a hospital executive that not only says they want data exchange, but then does something about it.  I have my money on nobody coming up with one.



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