Name: Insights: Why Electronic Health Records Failed to Become a Nationwide Network
Uploaded: 2020-07-21
Duration: 7 min 4 s
Description: Years after their adoption, electronic health records still haven't lived up to their potential.

 - It's now been 10 years since the EHR and center program was created, yet we still do not have adequate levels of interoperability. - So we can sequence the entire human genome, but we still can't get much more than a printout, a fax, or CD Rom when we leave the doctor's office. - But often we are delivering care with a fractured medical record. - The electronic health record unfortunately, was introduced as a halfway technology. - The promise was that everybody in America, would be able to have their own personal electronic health record, you'd be able to monitor your health more closely, you'd be able to communicate back and forth with your doctor. And for most people, that hasn't really happened. ILANA YURKIEWICZ: The whole goal or one of the major goals of converting paper records to electronic charts was, ease of data entry and retrieving data, so that this can be shared in a straightforward way. BOB KOCHER: Question is why is it so hard to get your information, I mean it's your information that is in the computer? Should be like, select and print, and get it. ERIKA FRY: Interoperability is the term the industry uses for do these systems, communicate with each other, can they share health data with each other. And right now, we're trying to get to a very basic level of interoperability, which is to send and share very basic data sets. The idea that all the information in one system can be shared with another, is a long ways off. FRED SCHULTE: The idea of interoperability used to have sort of a seamless national system in which health data can be shared by vast quantities. Both for the treatment of diseases and for the ease at which you can have your records sent or someone can send the records on your behalf. That could save your life. - The interoperability problem is one that's been more and more intractable than I expected. And so I think we probably should have thought about ways at the beginning, require it. At least, for some aspects, for safety, to require it. Because the economic incentives are such that it's hard they could make that happen on its own. ILANA YURKIEWICZ: We have hundreds of different electronic vendors in this country. And they often all operate independently. JON LOMURRO: Why should epic this huge company have to share its information with EMR 2 or whatever you want to call this local. GALEN MULROONEY: Historically, there have been a lot of proprietary coding systems that were built as part of products. There are about five or six well-known companies, all of whom invested millions of millions of dollars trying to get that information correct and that knowledge is proprietary. And they rightfully, don't want to give it up. ILANA YURKIEWICZ: While most doctors offices and hospitals have gone paperless and they use electronic records, those records are not shared or integrated with other facilities. SEEMA VERMA: Essentially, where is your information was in a filing cabinet. Now, it's in an electronic filing cabinet. So we don't have a system where data is traveling seamlessly with the patient as they go through the health system. - Hospitals don't want their patients to go across the street to the competitor really easily. And so they make their computers not share all the information because they don't want the patients to leave. ILANA YURKIEWICZ: When I first started in this role, I think I had this naive expectation that all of the information that I wanted and needed to properly take care of patients would be available to me in an easily accessible formats. It didn't take long before I figured out that, that's not at all the case. In order to get information about our patients, we need to do a lot of sleuthing, and a lot of legwork, and a lot of obtaining outside records and information. And that process can be very cumbersome and it can take a long time. - There were so many, very quick installations of this equipment to recoup the stimulus money. There were doubts and questions, and still are questions whether in fact, the requirements were being met by some of these vendors. - Very careful checks have to be done to make sure that the patient safety checks are operating properly. JON LOMURRO: I got data coming in from another system and there's something wrong in that data, that's misinterpreted my system, now, all of the fanciest clinical decision support systems that I just spent huge amounts of money and time on, are going to misfire. And it's either going to not tell me to do something when it needs to or it's going to tell me to do something when I shouldn't. And you know that's dangerous, you could kill somebody. - There's been a lot of examples in which the electronic health records have mixed up patients and put information about one patient in the wrong file. You get other situations in which doctors order a test. And then by some kind of a software glitch, it disappears before it gets sent to the lab. And so the doctor could be waiting around for a test result, and not realize that the test never got to the lab. - So there are a couple of important things that need to happen to improve our usability and safety. So the first one is, we have to have more effective HR usability and safety testing. The second important piece is that, many of the contracts that exist between HR vendors and provider organizations, health care provider organizations contain language that are often termed gag clauses that prevent the open communication and sharing of usability and safety challenges. FRED SCHULTE: There's just been a culture of complete secrecy in this industry, which has prohibited a lot of people from honestly talking about the problem. There's confidentiality clauses that say pretty threateningly, that you're not to share any information about how much you paid for this system, about any problems you see with the system. You can't really call your buddy at another hospital and say, you know we installed such a such a system. And man it's garbage. - The companies say they're protecting intellectual property, but many safety experts say, this really is preventing wide spread learning on these safety risks. - The driver of everything, the most important person in this entire story, is the patients. And just like doctors and nurses should have access to all of their information in a way that they can make informed health care decisions. Patients need access to their own information too. So they can manage that properly, bring it to other providers, or just have it for their own-- for their own sake and their own knowledge. - We could somehow find a way to put the patients first, then the opportunity is there. Because if everything is recorded and everyone listens to flags and warnings, then they will catch things we can't even dream of. And that's fantastic. 

Years after their adoption, electronic health records still haven't lived up to their potential.