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Electronic Health Records: A New Road Leading to the Bridge to Nowhere?

Originally published December 7, 2009

Bravo. The government finally has its healthcare IT priorities straight. Unfortunately, it won’t be able to achieve them.

As a healthcare IT specialist, I have worked around the world helping other countries achieve what the U.S. is trying to achieve. It is thrilling to see so much activity and financial support from the U.S. government going toward broader healthcare IT initiatives.

The Department of Health and Human Services (HHS) has issued a draft definition of the “meaningful use” of electronic health records. Organizations that meet this definition and treat Medicare and Medicaid patients are eligible to receive health IT stimulus funds for those projects.

The priorities outlined in this document are spot-on:

  • Improve quality, safety, efficiency, and reduce health disparities

  • Engage patients and families

  • Improve care coordination

  • Improve population and public health

  • Ensure adequate privacy and security protections for personal health information
Setting priorities and achieving them, however, are two distinct challenges. Perhaps the biggest hurdle is the technology – or, the lack of understanding of the impact of the technology.

Much ado has been made over electronic health records (EHRs) and the role they will play in achieving President Obama’s objectives of lowering cost and improving delivery of healthcare. But there is a serious lack of understanding about the impact this technology will or, more to the point, won’t have in achieving the stated priorities.

Simply computerizing healthcare records will not achieve the outlined priorities.

EHRs are certainly important. However, there is nothing in place to prevent the creation of multiple EHRs for a single individual, added by the many organizations serving that patient. The same problems that arise from lack of visibility into medical history, like drug allergies, will persist. Duplicate testing will continue. Money will still be wasted.

For America to get the kind of collaborative care we desperately need – where health providers deliver cost-effective, quality care – it will take more than simply creating EHRs.

Duplicate records must be matched, linked and resolved to create a single, accurate view of the health history of the individual. That “view” needs to be within reach of the treating healthcare professional. That single, accurate view must bridge across a continuum of care.

Unless we get EHR on the road to reform, EHRs are a new road on a bridge to nowhere.

Patient: Susan Davis Klein

Let’s take the example of fictitious patient Susan Davis Klein. Susan Davis Klein is in a car accident. She is brought to the hospital unconscious. The hospital has no records for a Susan Davis Klein. Two nearby hospitals have potentially matching records – one for a Sue Davis, one for a Susan Klein. The woman’s license shows an address that does not match either record.

There is a workplace ID card in her wallet, but none of the hospitals has the technology that would be able to connect the information on the ID card with the correct electronic record for the accident victim.

So, a third record is created, for Susan Davis Klein, populated with the address from Susan Davis Klein’s driver’s license.

Now we have multiple electronic records of one patient within the healthcare ecosystem. Not one of the records is completely correct, and in this scenario there is no technology in place to recognize the duplication, correct the error, or even correctly identify the patient.

Not only is Susan Davis Klein in danger because caregivers don’t know her health history, which may include an allergy to medications, but thousands of dollars worth of duplicate tests are being performed because the multiple EHRs are not being linked. There is no way to know what tests she has already had and where those results are stored.

The example of Susan Davis Klein is a common scenario.

Taking a Look Around

How can healthcare providers enhance the accuracy of EHRs and, in turn, provide better care for citizens? How can we ensure that EHRs do not become a road on the bridge to nowhere?

Take a look around, and learn.

The technology necessary for achieving the priorities mapped out in the HHS Health IT Policy Committee document exists and is being used successfully today. The key is not necessarily the EHR, but the ability to connect a variety of healthcare organizations so that there is one, accurate EHR that facilitates patient-centric, coordinated healthcare.

There are several well-publicized examples of this. One example is CareSpark, a program in the Appalachian region that connects physicians, hospitals, public health departments, pharmacies, laboratories, and imaging centers so that each can communicate electronically. The system encompasses 17 counties in the area of Virginia and Tennessee; it includes about 750,000 residents, 21 hospitals, and 1,200 physicians.

If a patient within the CareSpark system is admitted to a hospital after a car accident – as Susan Davis Klein was – the hospital would quickly develop a complete, accurate record of the patient’s medical history. If Susan David Klein were part of CareSpark, her information would be up to date: all her test results would be available, as well as allergy information, medication history, family medical history, and much more.

One Patient, One Record

The key to achieving the priorities mentioned above is being able to identify the patient with certainty. If you can’t do this within and across the healthcare ecosystem, you’re dead in the water. If the entire population of the United States has multiple – potentially incomplete – electronic records you haven’t accomplished anything.

Computerizing healthcare and having an EHR for each citizen is a great first step. But it must go hand-in-hand with a way to ensure that only one record exists for each citizen; it must be coupled with a way to ensure healthcare organizations that their records are accurate, up to date, and correct.

We must have a way to establish that single, accurate view. With that, the other pieces will begin to fall into place, and our road will begin to point in the right direction.


SOURCE: Electronic Health Records: A New Road Leading to the Bridge to Nowhere?

  • Lorraine Fernandes
    Lorraine Fernandes, RHIA, is vice president and ambassador for Initiate Systems,  a leader in enabling healthcare organizations to strategically leverage and share critical data assets. Lorraine is a nationally known expert on electronic health records in association with regional health information organizations (RHIO), health data exchange and patient identification issues. Lorraine can be reached at lfernandes@initiatesystems.com.


 

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Posted December 10, 2009 by LAgosta@acm.org

Very nice. Even though [full disclosure], I also publish to this channel I would like to point out the similarity between the challenge of a single, functional, workable patient identifier and the challenge in the days of customer relationship management (CRM) of obtaining a single, consistent, unified (360 degree) view of the buyer. A nice example of how a 360 degree view of the patient (or even a 180 degree view) can make a big difference in reducing costs - and save a life. "One patient, one record [file]" is a powerful proposal and vision. It requires moving beyond the EMR (which, as this article point out, we have not even gotten to yet) and advancing to a universal medical record UMR). It would be interesting to address the policy implications of [another] national identifier as a follow up. In the meantime, good, solid identification, deduplication, and data quality software will contribute to addressing the challenge. When is a good time to talk? Thanks!

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