The promise of the EHR

Editor’s Note: Physician Practice’s blog features contributions from members of the medical community. These blogs are an opportunity for professionals to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions are that of the writers and do not necessarily reflect the opinions of Physicians Practice or UBM.

The dream of every provider is to have an EHR that is easy and fast to use, creates an accurate record, and gives the provider access to all the patient’s previous health and diagnostic data in real time. We are not there yet.

While nearly every organization and facility has a least a rudimentary EHR, we are far from the point where I, the patient’s provider, can gather needed information from one place to safely and efficiently develop a treatment plan and prescribe necessary medications and care with confidence. All too often in the hospital environment in which I work, we get snippets of information and have to rely on the patient to give us an accurate picture of past care.  

This leads to a fragmentation of care at best, and medical errors at worst, all of which can harm the patient. Part of the problem is “interoperability” of EHRs, or, rather, the lack thereof. This is too complex a problem to deal with in this blog, but suffice it to say that with at least 16 big vendors nationwide developing their product in a “silo,” there is no real interest or incentive for these organization to talk to each other in any meaningful way. It is a significant road block to what providers need the care for patients. But there is hope.

In the state of Virginia, a meaningful, real-time connection has been achieved at the ED level so that patient health plans, patient registries, and patient prescribing data are on a single network. This is the first state to accomplish this. They are able to avoid repeated and unnecessary diagnostic testing and prescribing, and they have access to patient information at a higher level of confidence than patient memory or paper records.

Virginia aims to expand this network to include other downstream providers, including primary care physicians, case managers, nursing homes, private behavioral health providers, and Federally Qualified Health Centers, who will have the ability to use the technology to receive alerts and contribute to patients' care guidelines.

I believe Virginia is on the cutting edge of EHR change and advancement. Other entities, organizations, and states will get with the program and implement systems such as this. You would think that with so much digital data available, it would be easy, right? This has not been the case as EHR vendors have developed proprietary systems, so they protect their data and technology as they have much time, energy, and money invested in their product.

The interoperability of the EHR is a critical public health matter, and the government should have a more active role in mandating that folks work together, in my opinion. There is an interoperability “road map,” and strategic plan at HealthIT.gov. But it is unclear what is the current role of the government in getting all players together to get on the same page by 2020.

For now, when I see patients and consults from outside of my facility, I have access to electronic patient data and diagnostics only if they were seen within my hospital system. While this does cover a broad geographic area, there are manyfacilities gathering digital patient information in the same area. My system can’t “talk” to their system, so I am forced to rely on phone calls, faxes, hand carried diagnostic data on digital media, and hand-carried paper to develop an effective and real-time treatment plan for the patients under the care of our team. So much of our time is consumed by this process, and I believe that it results in a high level of frustration, leading to a significant reduction of quality of life for all health care providers.

In California, we have a long way to go to follow the path being blazed in Virginia. It is everyone’s goal to get there. In the past ten years, we have come so far with the EHR, and these systems have improved patient care and reduced errors. To be fair, they have also created a new source of medical errors, of which I have written in the past. The potential for the EHR far outweighs the risks and challenges. It is such a monumental project and will lead to a fundamental change in the delivery of healthcare in the U.S. and the world. It is worth doing, and worth doing right.