Electronic health records – Stuck in the 1990s?

Washington Watch

Recently I needed some medical records sent from my previous doctor to a new specialist. I was stunned when this thoroughly modern medical practice told me the only way they could send them quickly was with a fax machine. When was the last time you used a fax machine? 1990s technology in 2018?

Efforts to develop a standardized electronic health record (EHR) system to make it easier for the sharing of your medical records between doctors have been planned since that fax machine was the latest technology invention, but only with limited success. Most medical practice and hospitals now have their own EHR systems, but problems continue in efforts to share records between competing facilities.

Lack of patient health data access often leads to duplicate testing and unnecessary treatments, increasing costs for consumers, doctors, hospitals and health systems. Medicare continues to push forward on its efforts, but those efforts have, so far, gone nowhere.

At a recent speech, Seema Verma, who heads the Centers for Medicare and Medicaid Services (CMS), noted that “providers also continue to find it difficult and burdensome to use EHRs. In the era of artificial intelligence, machine learning and precision medicine, fax machines continue to be the go-to technology for providers transmitting health information.”

Verma wants to change that and detailed the federal agency’s plans to implement a health data exchange system that ensures patients have control of their own health data. But she stressed the agency will not be able to achieve this kind of system “until we put the patient at the center of our healthcare system. Until patients can make their own decisions based on quality and value, health care costs will continue to grow at an unsustainable rate,” she told a health information technology conference in Las Vegas in March.

Right now, 78 percent of doctors and 96 percent of hospitals use electronic health records. But gaining access to them has long been a challenge in the U.S. because it’s in the providers’ financial interest to keep a tight hold on patient information.

As many of us have learned, patients often have to go from one doctor’s office to another to gather up copies of your own medical records. More often than not, it’s difficult and sometimes impossible to put together your complete medical files – especially if you’ve had surgeries at two or more different hospitals or lived in multiple states.

Verma predicts that one in every five dollars spent in the U.S. will go toward the healthcare industry by 2026. “When providers don’t have timely patient information readily available, tests are repeated, and we are paying for unnecessary treatments,” she said. “All this drives up costs and puts patient safety and quality of care at risk.”

HIPAA, the health care privacy law, further complicates sharing medical records. Part of the blame, she acknowledges, is due to outdated Medicare regulations, most of which were designed to suit a health care system using paper-based records back in the fax era.

“In many ways, EHRs have merely replaced paper silos with electronic ones, while providers, and the patients they serve, still have difficulty obtaining health records,” she said. “For the fortunate few who do ultimately obtain their records, the information is often incomplete, and not always digital or understandable.”

A new initiative, the MyHealthEData initiative, which will be led by the White House Office of American Innovation, aims to allow patients to obtain electronic versions of their medical records from all of their providers, regardless of whether they are in the same physician practice or hospital system. The hope is to also allow doctors to more easily share your records at your request.

Verma’s own CMS is planning to upgrade its Blue Button program, which provides traditional Medicare enrollees with their claims data. The overhaul will let developers build phone and computer apps that will allow patients access to their own information. Right now, though, seniors can only obtain their data by downloading PDF files.

The agency will also push Medicare Advantage and Obamacare exchanges to release their data to patients in a secure format and will specify what information (hopefully in electronic form) hospitals must share with patients when they are discharged. Right now, hospitals and doctors’ offices are not required to give you a copy of your medical records.