When the Model T Ford was introduced, consumers were thrilled -- who cared if it didn't have a roof or windshield wipers? It was better than a horse and buggy, and completely altered the transportation industry. The only catch was the color, which prompted the famous line, "Any color you want, as long as it's black."
Electronic Health Records (EHRs) heralded the same promise of turning the healthcare industry on its head. But unlike EHRs, the Model T Ford evolved, standardizing safety features like seat belts, and creating options like mini and electric, all offered in many colors. While automobiles can be different, the basis is the same: Anyone who can drive, can drive any car in the world. EHRs should work the same, but they don't.
EHRs have commendable goals: 1) Creating forms that provide a comprehensive overview of an individual's medical history, and 2) Making those forms easily accessible by patients and care givers of any organization. The first goal has been achieved -- EHRs serve as excellent means of storing information. But in order to become truly useful, EHRs need to go beyond storing information and become readable, searchable and transferable.
Most EHRs are institutionally specific, making transferring or sharing information a huge, if not impossible, pain for patients. My family recently switched healthcare plans, and we changed many of our care providers. This meant we had to physically visit each doctor office and hospital each member of our family attended, and personally make the request for records. Faced with receiving records in CD, email or print formats, we opted for boxes and boxes of files. Believe it or not, this was the easiest route: If we went the electronic route, we would have had to remedy issues about formats, readability, encryption and passwords -- for each file.
Once the data is uploaded to the new office or hospital, the process is still not complete, as the data only resides in one place, the media tab. It should be distributed throughout appropriate offices like radiology and labs, and I'm hoping this will be accomplished in the future.
Fragmented Patient Care
The workflow in EHRs is disjointed, which equates to fragmented patient care. The typical treatment process is this: When asked to consult on a patient, I review the admitting docs and read 3-5 pages of previous treatments to make sure I understand the situation to date, including the history. When I'm done with my treatment/recommendation, I write it down so the next expert also has the history and latest information in chronological order. The data in EHRs is not linear, which interrupts the workflow. For example, doctors using EHRs have to find timestamps, and then determine if the timestamps reflect the day of the activity or the day of the sign-off, which could be days apart. This makes it hard to understand critical care details, which delays care while sorting out the info.
Facetime Equals Screen Time
A doctor is often busy multitasking -- chatting with patients while making entries in the EHR. When speaking with patients, it's important to pay attention to their facial and body expressions (i.e., Why did you squint? Why are you shrugging your shoulders?) Doctors need to make sure patients are comfortable with the situation and understand the recommendation, and you can't read body language when you are looking at a screen.
MUMPS: Database or Disease, Both Are Bad
EHRs are built on an archaic system, which makes them inflexible and incredibly difficult to read, search and find information. Forty-percent of the U.S. population stores its heath data in an Epic EHR, which is based on the MUMPS (Multi-User Multi-Programming System) database --a technology that was designed in 1966. So you can understand why it nearly takes an act of God to make a simple change to an EHR, such as the way we report medical dosages. And this is critical, if not life-threatening. Even EHRs within an organization need to be customized: Kaiser patients in Redding, CA, and Kaiser patients in San Francisco are going have socioeconomic differences, suffer from different ailments, etc. and as such will need different EHR templates. Medicine is always changing and we need a system that can adjust appropriately.
EHRs have taken the first step in establishing a working repository to store patients' health data, and it's time to take the next step to making the data readable, usable and transferable. The Health Level Seven International (HL7) is a not-for-profit that is working to establish standards for EHR portability but hospitals aren't embracing the standards, citing security and privacy concerns. But if the government (efiling for taxes) and financial institutions (transferring money) can get past these issues, so can the healthcare industry.
The next wave of EHRs need to evolve like the Model T, adding new features and offering customers and physicians customizations while making them usable to all. They need to be created by doctors, who understand the data and process, and engineers, who understand the technology. Three years from now, you should be able to access all your health files from any device, and share them with your Sherpa, shaman or surgeon.