It might seem like we are living in the technologically advanced society prophesied by Verne, Asimov and Wells. After all, nearly everyone has their own handheld computer that links to all the data ever compiled across the globe. Artificial intelligence has become a reality, and every day a new robot is introduced to complete a previously manual task. All we’re missing are a few flying cars and maybe some self-tying shoelaces, right?
Then we visit the doctor. And suddenly we realize just how archaic some of our most common processes remain. We fill out 20 pages of documents at one doctor, only to go a few doors down and have to answer the exact same questions. We pick up a prescription at one pharmacy, but another location in the same chain may not have any record of the transaction.
For those who take medication – almost 60 percent of us in the United States alone – the lack of continuity can prove disastrous. Each year, preventable medication mistakes result in between 1.5 and 2.7 million hospitalizations. How many of those could be avoided if every pharmacist was looking at the same information?
It happened to me a few years back. I was working at a call center when I caught a nasty case of bronchitis. If you’ve never tried to talk on the phone for eight hours a day while you barely talk or even catch your breath, it’s not a fun experience. But like many employers, the company did not excuse absences for medical issues, no matter what kind of doctor’s note was provided. Employees earned paid sick days, but were penalized for using them.
Finding myself in this frustrating conundrum, I knew I needed to see a doctor, but also knew I couldn’t afford to miss work waiting for an appointment. So, I hopped over to a nearby walk-in clinic to try and get some aid. As always, I filled out the typical questionnaire, ensuring I listed each of my daily prescription medications. I got a script for some antibiotics and an inhaler, filled them at the closest pharmacy, and headed back to work.
Little did I know, the doctor at the clinic prescribed me an antibiotic that interfered with one of my main medications, one that allows me to function on a daily basis. The doctor should have known better. And had I had time to visit my usual pharmacy, my pharmacist probably would have recognized the conflict.
But that wasn’t the case, and about 10 days later I started to slowly become ill from an otherwise treated chronic condition. It took weeks to re-establish the proper medication regimen, and I missed far more work. It took months to fully recover — medically and financially — from the mistake.
I was lucky. Pharmaceutical errors have far more disastrous effects than what I experienced. The World Health Organization explains that undesirable outcomes from medication “may have significant health and economic consequences, including the increased use of health services, preventable medication-related hospital admissions and death.”
According to U.S. News and World Report, a recent analysis estimates that 128,000 Americans die each year as a result of taking medications as prescribed – nearly five times the number killed by overdosing on prescription painkillers and heroin.
Medication errors are truly a global issue. For example, a United Kingdom study found 12 percent of all primary care patients may be affected by a prescribing or monitoring error over the course of a year, and another study in Mexico observed at much as 58 percent of prescriptions contained errors.
Such a common yet preventable issue has received plenty of notice from WHO, which compiled a list of likely pharmaceutical error causes. Some of the most common factors include inadequate knowledge of the patient, poor communication, lack of standardized procedures, incompatible systems, poor patient monitoring and inaccurate or incomplete patient records.
Electronic Medical Records
Why is it still so difficult for medical providers to communicate with one another? Industry insiders wonder the same thing.
"Thousands of people are dying, and we've been talking about this problem for ages," Glen Tullman, CEO of Allscripts, a Chicago-based health care technology company, told TIME. "This is crazy. We have the technology today to prevent these errors, so why aren't we doing it?"
Although some doctors have been prescribing electronically for years, many still use pen and paper. In fact, Tullman said even though 90 percent of the country's approximately 550,000 doctors have access to the Internet, less than 10 percent of them have invested the time and money needed to consistently issue e-prescriptions.
To address the problem—and give electronic medical records a healthy push toward universal adoption—a team of health-care and technology companies launched a program that allows all U.S.-based doctors to write electronic prescriptions at no cost.
The National e-prescribing Patient Safety Initiative (NEPSI) offers doctors access to eRx Now, a Web-based tool that physicians can use to write prescriptions electronically, check for potentially harmful drug interactions and ensure that pharmacies provide appropriate medications and dosages.
"Our goal long-term is to get the prescription pads out of doctors' hands, to get them working on computers," Scott Wells, a Dell vice-president of marketing, told TIME. “Google is designing a custom search engine with NEPSI to assist doctors looking for health data. Insurance companies such as Aetna have pledged to provide incentives for physicians using e-prescription systems.”
Wider adoption of e-prescribing could lead to the more efficient keeping of medical records, which many believe is vital to both improving health care delivery and lowering costs.
Maria Palombini, director of emerging communities and initiatives development at the IEEE Standards Association, recently recounted frustrations similar to my own at the HIMSS Healthcare Security Forum in Boston.
"How many times have you gone to the doctor and they ask, 'What medicine are you taking? What is your wearable telling you?'" Paombini asked. "Why are you spending 15 minutes of your time with your doctor re-reciting something you think is written down in his chart from the last time you were there? Especially if you go to a new doctor, you want him to be able to have your health record."
Palombini even recalled a recent experience taking her elderly father-in-law to the emergency room.
"We check into the emergency room, and they ask us why we're here, they start asking him for all of this information: 'What kind of procedure did you have? What medicine are you taking? What's your health history?' she recounted. “Then, later, the ER doctor started "asking us all of the same questions again. I thought, 'Didn't you just read all of the information we just filled out at the registrar?'"
Finally, her father-in-law was advised he’d need to be admitted overnight.
"So, we head upstairs to the next floor, where we get asked the same questions once again," she said. "I'm sitting there, thinking out loud, and I say, 'Blockchain would have solved this problem.'"
Palombini said a public blockchain could be just the thing to enable more seamless – but still secure – sharing of health data, all within the patient's discretion and control. In fact, technologists and health-care professionals across the globe see blockchain technology as a way to more seamlessly and securely share medical records, protect sensitive data from hackers and give patients added control over their own information.
But before an industry-wide revolution in medical data is possible, the construction of a new technical infrastructure—a custom-built “health-care blockchain”— is necessary.
"Everything you have in your health record gets put into the blockchain, and then the patient is managing their health record," Palombini explained. "I have my health record, and then I go to my doctor I give him a token to access my records.”
Specialized blockchain software, such as that used by Embleema, can not only track who can access which aspects of a patient’s medical history, but also safeguard who can view and who can alter or made additions to it. Meanwhile, it could also perform continuous data integrity tests to detect and immediately deter any hacking attempts.
Therefore, anything a doctor logs on the blockchain would become part of a patient’s universal record, no matter which electronic system the doctor uses. So, any other authorized doctor, nurse, pharmacist or caregiver could also access it without concern for incompatible systems.
Plus, any updates about medications, problems, and allergies would be universally connected to an open-source, community-wide trusted ledger. Instead of just displaying information from a single database, the record could display data from the entire ledger.
I know such a simple advancement could have saved me a great deal of pain and frustration when I was prescribed the wrong medication — and that was just an antibiotic! Imagine the lives that will be saved if all our medical caregivers are finally on the same page.