A recent news headline read, “Bipartisan committee wants government-subsidized electronic records systems scrutinized for ‘information blocking.’” *
The question before the US Senate Appropriations Committee is whether taxpayer-funded EHR software solutions are now preventing the unrestricted exchange of medical records between health care organizations. If this is in fact the case, this undermines the Affordable Care Act and is a considerable waste of taxpayers’ money… and that money is considerable. The US$27B authorized as financial incentives for providers that implement EHR systems has driven broad adoption. However, one of the main goals behind broad EHR adoption was to expose the health care data that historically has been buried in the paper charts in filing cabinets.
The question before the Senate Appropriations Committee should be much broader. It's not just if the EHR systems are “preventing or inhibiting” unrestricted exchange of medical records. It's also whether these systems are enabling providers to readily store, access and mine the breadth and depth of all of the patient data generated within their own system. Think lab values, medical device data, and unstructured data as examples. Additionally, to be clear, we are not talking about securing access to the EHR data through a multi-week or multi-month consulting engagement by which the EHR vendor extracts the data from the provider’s EHR system and then delivers that data to the provider for their exploration. This is certainly feasible and may be a lucrative business for the EHR vendors, but it undermines the intent of the EHR systems. We know what e-Patient Dave would say, “Give me my darn data!”
The US health care system needs unencumbered real-time access to all of the data in the EHR systems – and this includes date/time stamps and facility/clinician signatures on all elements of a patient record. This will enable insights to be mined from the data under the premise that the data is freely accessible, and it enables data to be funneled back into the EHR and appended to individual patient records.
The promise of the triple aim relies in-part on the ability to leverage medical and other data to have a holistic picture of patients to identify what treatment approach is best for which patient at lowest possible cost. However, if data is inaccessible, realizing the goal of the triple aim will be in jeopardy.
If you work in health care, make sure that the data of your patients is easily accessible to you, your colleagues, and other providers in the care continuum of your patients for whatever purposes associated with improving care, decreasing costs and improving your patients’ experience.
If you work outside health care in the US, call the bipartisan appropriations committee. These are your tax dollars at risk of not delivering on the goal of improved care at a lower total cost for all of us.
Hopefully, the senate appropriates committee is coached on the fact that it is not just data “exchange.” It is about much more, including:
- Ensuring that the data within the EHRs is of robust quality and can be easily exposed for the purposes of combining with data outside the EHR;
- Enabling the mining of combined data sets, both structured and unstructured, to capture insights about patient outcomes;
- Surfacing insights as to how clinical variability impacts patients; and
- Facilitating the appending of data to patient records such that externally generated data (e.g. patient scores) can be embedded back into the patient workflow.
As the 2009 American Recovery and Reinvestment Act authorizes a net $27 billion in spending to support EHR adoption through 2017, lawmakers must fund the program each year. These are our tax dollars at-work or not-at-work due to data being potentially locked into the vaults of EHR software solutions. We need to see the EHR systems delivering on their true potential to enable improved care and lower costs, versus being the most sophisticated and expense filing cabinets in history.
* USF Health, Morsani College of Medicine, University of South Florida, “Senate Committee Calls for EHR Interoperability Investigation, Aug. 5, 2014.