Health information exchange is the foundation of care coordination

My wife Elaine was hospitalized for 6 days recently with an array of ailments related to her advancing cancer, so diagnosing and addressing her problems required a multidisciplinary approach. In addition to the nursing and support staffs, she was tended by an emergency physician, two hospitalists, three gastroenterologists, a pulmonologist, an infectious disease physician and an interventional radiologist. With the exception of one specialist who had performed a procedure on her two weeks earlier, this episode was the first time any had met Elaine.

Each clinician was familiar with her status before visiting her, because the health system has an enterprise-wide electronic health record (EHR) that aggregates information into each patient’s chart. The hospitalists coordinated the care process and also touched base with Elaine’s primary care physician and her oncologist.

In other words, the system worked exactly like we hoped it would but often doesn’t. Especially in complex cases like this, the likelihood of a positive result is enhanced if the team members have access to the same complete information, and if someone – in this case the hospitalists – quarterbacks the activity.

Of course, this was possible because all the care occurred within a single health system that has a unified EHR. Information from EHRs in independent physician practices or ambulatory care sites – lab results, images, previous complaints, drugs and dosages – is unlikely to be merged, because the systems can’t talk. The same thing holds between health systems. Health care is currently an archipelago of information islands.

Information isn’t shared, not because it isn’t important, but because the nation’s EHR vendors have not committed to implement standardized protocols that can allow all health care information to “interoperate,” or flow seamlessly from one system to another.

There has been lots of policy discussion about interoperability, but EHR vendors have dragged their feet, and for good reason. A significant part of this is about protecting market share. If EHR customers can easily move their data to another platform, it also becomes easier to switch to a different platform.

But the care and cost consequences of this industry-wide strategy have been catastrophic. The barriers to merging pockets of data mean that physicians working with the same patient make decisions based on different incomplete data sets. This degrades attempts at objective evaluation, produces conflicting conclusions, impedes care collaboration and coordination, results in poorer outcomes and generates higher cost. It is not unreasonable to believe that this single issue unnecessarily costs the American people thousands of lives and hundreds of billions of dollars each year.

Some have argued that by 2014, the elements will be in place for safe, seamless health information exchange. But the incentives must be powerful, firmly in place and non-negotiable. Any industry that has shown a willingness to harm its customers for its own benefit over a period of years is not likely to simply cave without a fight.

The technologies required to exchange patient information are available and well understood. Our permissiveness in allowing systems to remain isolated has tied medical professionals‘ hands, caused patients to suffer unnecessarily, and exacerbated the already out-of-control health costs that threaten our larger economy.

American health care is too important to be left purely to market forces in some areas. Health information exchange is the foundation of care coordination, and so certainly fits that criterion. We need a zero-tolerance policy that mandates safe, secure health information interoperability, and severe penalties, like a market ban on products that do not align with exchange requirements, when products do not comply with standard protocols.

As in so many other areas of health care, employers and other powerful groups could leverage their own strength to redefine health care practice in ways that serves patients’ and purchasers’ interests first, rather than the other way around.

Brian Klepper is Chief Development Officer of WeCare TLC and blogs at Care and Cost.

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  • margo

    I have noticed that my local hospital has changed their EHR system multiple times. Seems it can never be resolved. Can you explain further the politics involved from your article?

  • Elegia More

    How to you plan to deal with the massive amount of MISTAKES in electronic med records?

    I’ve been to the head of a hospital and a state wide huge doctor group, to my individual physicians and NOBODY will correct dangerously wrong info in my electronic file. NOBODY. The best I can get is that they will post at the bottom of my chart in small print that the stuff at the TOP is wrong!

    One hospital had omitted entering all my new patient records from Mayo and elsewhere explaining my rare condition, yet I was told I didn’t have to bring all my paperwork to the ER during a heart attack. So in the ER I was given contraindicated meds and wasn’t allowed to refuse them because they did NOT have my medical paperwork ENTERED INTO THE SYSTEM.

    My physician was on vacation so nobody knew about my rare condition; Call explaining my odd condition from Cleveland Clinic were ignored while my hospitalist called me a liar to my face, while actively having a heart attack. Bringing the original paperwork didn’t help as the hospitalist would not admit he had been wrong and continued improper meds. Finally I checked out in an unstable condition per my cardiologist’s request! Missing electronic records were more “valid” that the hard copies in my hand!

    Today I carry a letter in my wallet with medical proof of my condition. But will it be read in an emergency or will they go by the WRONG info I can’t get off my health records?

    Of course, this is the plan. As a younger person on Medicare for a life ending condition, I’m the person y’all want to die and clean out the system. Keep screwing up my medical records and I will.

  • http://www.facebook.com/jay.luttrell Jay Luttrell

    Well since you’re in the mood to “interoperate”, does your athenahealth EHR system ready for stage 2 meaningful use yet? Do you have “direct” messaging built in already so that your customers can intuitively communicate with their colleagues who don’t use the same system?

  • http://twitter.com/FerkhamPasha Ferkham pasha

    This system will be very amazing in healthcare