Four Tall Hurdles to a Meaningful Electronic Medical Records (EMR) System

Electronic health records promise big ROI: empowering consumers to keep track of their health and make good choices, making doctors more efficient, reducing costs, all while protecting patients' privacy. But the effort is still in its infancy.

Microsoft has unveiled HealthVault, a program that allows consumers to keep their health records online. Google has plans in the works to do a similar program, and the web is full of offerings designed to give consumers more information about healthcare. But central to the issue of making electronic health records work is creating systems on a widespread basis that can talk to each other. Work around integration issues is ongoing, but there are four major challenges facing efforts to create a meaningful electronic medical records program in the United States.

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1. The landscape of electronic medical information is fragmented.

First, there is the issue of the types of records themselves: Electronic medical records (EMRs, which are also called electronic health records or EHRs) are the health care provider records of patient information and treatment, and include such things as doctor’s notes, blood test results and so on. By contrast, the term personal health records (also called PHRs) can be anything from a health plan supplied history of what tests a patient received (but not necessarily the results) to a mother’s tracking of a her family’s treatments, illnesses, and forays into fitness. It’s the area of electronic medical records that has received the lion’s share of attention from proponents of an improved way of treating healthcare data, while focusing little attention on the patient’s piece in all of this.

“While we’re seeing more and more movement to connect disparate parts of health care system to facilitate medical delivery, the effort to enable consumers to connect with health information is very immature,” says Janet Marchibroda, CEO and founder of the eHealth Initiative, a nonprofit group that seeks to use IT to improve healthcare.

Generally, health care information is thought of in disparate buckets: health care provider, health plan, and patient. “Nirvana, the one we’re all shooting towards is an electronic health record that our doctors have access to and we also have access to as we navigate our own health care,” she says. “Conceptually it requires having info about us in a patient-centric way. I have these allergies, I take these drugs.” She says that ideally consent to see what information would lie at the determination of the patient. “We haven’t figured all this out yet but you’re seeing change in the marketplace.”

2. Not many doctors use electronic health records.

There’s plenty of doctors who haven’t adopted any kind of electronic medical records, Marchibroda says. Research backs her up. Just 24 percent of doctors use electronic health records, according a study by the health care philanthropic group the Robert Wood Johnson Foundation. And although data is poor on the percentage of hospitals using EHRs, the report estimates 5 percent of hospitals use computerized physical order entry systems, which are a form of electronic medical records.

3. Technical standards vary, as do the use of medical terms for different data.

Bert Reese, CIO of Sentara Healthcare, a nonprofit healthcare provider in Virginia, points to the lack of common technical standards as another foundational problem. Hospitals and doctors, for the most part, use disparate systems that cannot talk to each other. The recent federal award of contracts totaling $22.5 million to nine health information exchanges to begin trial implementations of the Nationwide Health Information Network (NHIN) suggest progress. Nationwide Health Information Network But many see a long way to go before widespread interoperability exists.

In addition to the systems, there is a lack of standardization around medical terminology itself. For example, lab tests can be referred to in different ways, making it difficult for systems to share information, so even if systems can talk, the information itself isn’t consistent.

4. Who controls the data, and how can we protect patients’ privacy?

One thing that patients may not realize is that they don’t own their medical information the way it’s kept now. Consumers’ access to that eir own medical information is a big issue.

“There is still lots of fuzziness over whether a patient owns their own data,” says Francois de Brantes, national coordinator for Bridges to Excellence, a health care reform advocacy organization. DeBrantes points out that although it seems like you should be able to call a lab and request your data, more than likely it will only release the information to your doctor. “Because there’s such a lack of clarity and court testing of these concepts, most [ancillary health care providers] will quote you HIPAA as an excuse not to share your data with you,” he says, adding that in effect, your doctor, not you, is the primary owner of your information.

And as with any healthcare issue, there are disagreements about who should control the data. Some think such programs should be handled by hospitals, not the government.

“If [electronic health information] was managed by your doctor and your hospital in your community you’d feel better about it; in our focus groups they love the idea,” says Reese. He adds, “Our sense is that we don’t want government to fix it for us, the hospitals are discussing how we could make this work.”

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