29 Aug Electronic Health Records Don’t Exist, I Have A Patient Library
We have heard about this integration of technology and services that would let data flow seamlessly, so that communication between doctors, patients, insurance companies, pharmacies and the workplace would be unhindered. When first introduced, there was a big push for Return on Investment (ROI), but no one seems to mention this now. In fact, there is just dissatisfaction with the existing software. In my opinion, no one offers a truly comprehensive integration to genuinely improve patient care. And for patients, I still see the problems that existed since I started practicing in the 1980s.
Electronic Health Record screen (Photo credit: Laurence Chu, MD, FACS)
Let’s look at what has improved. I can click and type a note on the PC and retrieve it more efficiently than paper. There are no paper charts, and when a patient calls, the information can be found in seconds, not days. I can write a prescription, send it via electronic prescribing directly to the pharmacy, and evaluate the medication against what is already taken, to avoid interactions and allergies. The pharmacy receives a legible prescription to fill, helping to avoid medication errors. The same process goes towards laboratory studies and imaging (x-ray) studies. Services are billed via a government standard electronic form that has all the patient demographics, diagnosis codes and procedure codes pertaining to the office visit, hospital stay or surgery performed. Since information started electronic, it remains so. It is transferred to either the insurance company or to a clearinghouse that evaluates the information before going to the insurance company. This information is stored in the patient files, again electronic information. There is even a patient portal that may allow the patient to see aspects of the record online via secure personal access. Vendors like athenahealth, Cerner, eClinicalWorks, Epic and General Electric’s GE Healthcare address this side of the equation.
This sounds wonderful, but there is one important facet missing, and it affects patient care more than can be imagined. Authorization delays for medications, procedures, lab and imaging studies is commonplace. Ask any patient who has needed a Prior Authorization. For example, when a medication is not authorized, the pharmacy notifies the patient and my office. There is no efficient exchange of information electronically to the authorizing agent. My office is forced to re-enter all patient data manually into an online form, a paper form that is faxed or a staff member must call to verbally provide the information individually for each patient. This is repetitive, time consuming and inefficient. Furthermore, each company has a different policy and form required. It is not uncommon to then receive a verbal or faxed request for medical records, but no direct electronic communication exists, so the records are faxed. Not uncommonly, authorization is denied, so that a “peer to peer” phone call is needed. Now I, the physician, must call, verbally provide information again to try and obtain authorization.
So, in spite of the wonderful face of electronic information, there is a glaring gap causing me to regress to the 1980s. I need to fax, spend hours on auto-attendant hold and write out paper forms. Haven’t I spent thousands of dollars to create an efficient electronic office? Apparently not. The information that has been input into my Electronic Health Record is my information, not accessible for the purposes described. This is the failure of the EHR not truly reaching out beyond my office. So, in reality, I just have a patient library. If I need to send out information it is basically a Xerox copy, maybe even a ditto copy. There are some exceptions, with doctors and hospitals communicating, but the limitation I am describing affects them as well.
I believe we really need a universal interface built for all of the Electronic Medical Record systems that will allow comprehensive bi-directional communication with any chosen authorized partner. We already send in key information to the insurance company, why not include the medical record so the reviewer would have the information immediately. If prior authorization is needed, their system can notify my office through the software and I can electronically provide the information without having to re-enter it in another system. Since this remains in the system, all parties can see the communication and there is improved efficiency and more rapid authorization for medications, surgery or diagnostic testing. This will really provide better care, not just a data repository that meets regulatory requirements.