We need a better way to share information to care for patients

This evening I went to a meeting of many of the independent physicians in our community who came together to discuss ways we can help each other to remain viable as relatively small independent practices of medicine.  Two things about the meeting really hit home for me.

First is how seldom I get to meet socially with my fellow physicians in the community.  Now that many of us use hospitalists to take care of our patients when they need to be hospitalized, we seldom see each other face to face.

I was surprised how nice it felt to sit and break bread, well maybe have a beer too, with friends and colleagues I hadn’t seen in years.  I never was one of the docs who came to the hospital a little early each morning to share a cup of coffee with the other physicians, but I do miss discussing patients and sharing about family, friends, and the community news in person.  Phone discussions tend to be all business for me, and it’s just not the same.

Second is how frustrated everyone is at how difficult is has been to share medical information even though most of us use electronic health records.  Everyone desperately wants to have a HIPAA compliant, convenient, and practical way to share patient information so we can take better care of our patients.  This sounds easy.  Fax machines were a huge break thorough 25 years ago, but just don’t work well enough now.  The problem is that secure and confidential exchange of information between proprietary EHR systems that were not originally designed to communicate is neither simple nor inexpensive.

In addition, information is power.  Some large medical systems have financial incentive to make it easier for their own providers to have easier access to patient information.  This makes a big incentive to keep patients wholly within their system and capture the work and billing for the work of providing the care to those patients.  As independent physicians we just want to have access to the data we need to provide good care.

I was told tonight that putting up roadblocks to easy access to information is going to be illegal soon, essentially forcing all medical systems to make access to patient data to appropriate health care personnel easier.  I hope so, because this is one of the huge hassles of practice, and a significant factor in the overall cost of medical care in the US is duplicate testing and the work needed to gather patient data.

Let’s all keep pressure on everyone, physicians, hospitals, and government to do whatever it takes to facilitate ease of access to appropriate medical data.  Our health, and our economic success as a nation depend on it.

Edward Pullen is a family physician who blogs at DrPullen.com.

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  • stargirl65

    I have had an EHR for 10 years. It is like a lone island in a sea of other islands. I can communicate with my lab (for an extra fee of $50 per month due to a bridge) but no one else. Hospital records are scanned if paper delivered, or move by hand if faxed to us. If we access the hospital EHR then it is printed, scanned, then shredded. It can not be imported as they don’t talk to each other. The same goes for interacting with any other doctor’s office, lab, radiology center, etc. It even goes for other offices using the same EMR that I use. The EXCHANGE of information has never been a priority of these systems. It costs lots of money if you want to make it so.

  • Adam Alpers, DO

    I agree, I equate this whole system to the Microsoft/Apple issues of the 1990′s when the two different systems were juggling for position.. Of course, Microsoft initially won the battle and then Apple reinvented itself to be the player in the game it is today..

    On the other hand, the systems we are currently are dealing with were not thought enough in advance to be user friendly or “were” thought enough in advance to NOT be user friendly so we are required to “invest” more of our hard earned constantly reducing income to purchase compatable software that will enable us to get the records.

    I have no doubt that the systems will be able to merge the data, but not until we are forced to pay yet again for the privilege.

  • http://www.hybridhealthit.com/index.html RobertC

    It is refreshing that the small independent practices get it. EMRs are a vital component to create the infrastructure to a National Health Information Network (NHIN) that allows communication and collaboration between all members of a patient’s treatment team, all in the name of the patient’s well-being and improvement of the industry.

    There are interoperability standards that exist to do exactly what the small independent practices crave. For example, the Continuity of Care Document is an exchange standard for sharing patient summary information. Dr. Alper’s analogy about MS/Apple is so, so true on the proprietary obstacles.

    You are correct. The winds of change are coming. More awareness and advocacy are needed for this to happen. There are others of us who are thinking the same thing about sharing information. Thanks for your commentary.

  • http://www.innovativepdf.com Ted Rudolph

    Small practices are sometimes handicapped in that have to maintain the same standard of care as large practices with less resources. A lot of EMR systems are designed for hospitals and large pactices(that’s were the big money is), and scaled down to fit the smaller practices. This, of course, rarely works well for the small practices, because like the field of Pediatrics medicine found that children are not just small adults. They have their own challenges related to being children.

    The same is true about EMR systems. Small practices are not just scaled down large practices when it comes to EMR systems. They have their own challenges related to them. It is refreshing that some new startups have entered the EMR field specially for small practices. One is Practice Fusion (www.practicefusion.com) which is a FREE EMR system.

    Another tool that small practices can use is PDF Healthcare. Everyone knows and uses PDFs, but PDF Healthcare is a special movement to use PDFs as a way to exchange medical data. PDF is now an international standard(ISO 32000) and free PDF Readers are everywhere.

    The future is bright for small practices that can leverage their existing EMR system with other technologies in the healthcare field.

    • http://www.practicefusion.com Emily Peters

      Thanks for the Practice Fusion shout-out, Dr. Rudolph. We’re passionate about helping small medical practices across the country access the latest in health IT technology. Happy to answer any questions you might have.

      Emily
      http://www.practicefusion.com
      emily@practicefusion.com

  • http://www.perfectserve.com Terrell Edwards

    Everyone would agree that all physicians, including those at small independent practices, should have easy access to appropriate patient information. But this isn’t just about data exchange through EMRs. As William Bria, president of the Association of Medical Directors of Information Systems recently commented, “We need to start to focus not on the most exotic examples of information sharing, but on the more simplistic ones.”

    A good place to begin is by improving the ways physicians and other clinicians communicate with each other—whether in person, by phone or by text message. In fact, the Joint Commission has cited communication breakdown as the single greatest contributing factor to sentinel events and delays in care.

    Information sharing is about much more than EMRs, which essentially are tools to facilitate decision-making. Physicians need easy and cost-effective ways to adopt and access EMRs, but that’s only part of the solution. It’s also important that doctors have tools to collaborate more quickly and efficiently outside of the EMR. Think of it this way: An EMR won’t be of any use to a patient in the ED if the ED physician can’t reach the on-call specialist to determine the best course of action. This white paper has more information on EMRs and the challenges of “last mile” clinical communications.

  • Peter Duckler

    Great feedback Terry. The white paper is interesting. For KevinMD readers that are interested in reviewing it, you can download it here: http://www.perfectserve.com/hospital/docs/EMR.pdf

  • Reta Russell Houghton

    I find this sharing of information to be a very frustrating point for me as a patient. As a result I became a proactive patient. I started a PHR and have all my doctors give me copies of all labs and procedures that I can share with my doctors. I have kept lists of all my diagnosises, medications and hospitalizations I know my doctors appreciate it and have never had to have any test duplicated as a result.

  • Arthur Williams, MD

    My partner and I head two hospitalists groups in the Boston area, one acute care, the other a rehab hospital. For years our handoff communications went through paper mail or fax. We were very diligent about communication. Even so, specialist from acute care settings and primary care physicians in the community complained that our group was like a black box – that they were not getting good communication about the care we were providing. The hospital even setup a physician portal so that any on-staff doctor could log in remotely and access their patient’s information. But this “pull” model never caught on, as most doctors expect data to be “pushed” out to them.
    One of our new physicians suggested we look at Concentrica, which is an online network for secure clinical communication. We started with the Physician edition, which is free. The national directory of physicians meant that we could quickly send to any physician, without having to know their fax or email. Like an online email system, recipients can reply and forward messages, so now we could get immediate feedback from colleagues in other locations, and in important cases, have a real dialog about patient care. The “Group Discussions” feature allows the specialist in town, the hospitalist, and the PCP to all join in an online dialog about one patient.
    There is a Practice Edition, for a monthly fee, with additional features for groups with larger document handling needs.