The third year of medical school is when a student experiences the frustrations of medicine firsthand. Once, my team admitted a transfer patient from another hospital to treat a condition that was ravaging the patient’s lungs. But before we could act, we needed to rule out a dormant infection; if our patient was unknowingly infected with tuberculosis (TB), giving our first-line therapies could lead to a disseminated infection — even death.
The other hospital had already performed the necessary tests, including a TB culture from the patient’s lung fluid. Unfortunately, because the other hospital used a different electronic health record (EHR) system, it could not send us the patient’s updated digital health record. Instead, it sent us an 80-page printout with the TB result listed as “pending.” We considered repeating the test ourselves, but it was an invasive procedure, and, more alarmingly, our patient’s organs had started to fail.
The inability to share information efficiently is a common conundrum between clinics and hospitals. This is despite the fact that implementation of EHR was supposed to streamline the management of patient data. Currently, the exchange of patient information is hampered by the fact that there are lots different EHR systems out there, and they don’t talk to each other very well.
Without an efficient transfer of data, physicians have to re-gather patient history, reorder lab tests and make medical decisions based on incomplete information leading to unnecessary delays, wasted health care dollars and suboptimal patient care.
One solution is to mandate interoperability — which the Healthcare Information and Management Systems Society defines as the “extent to which systems and devices can exchange data and interpret that shared data” between the different EHR providers. As of now, the 21st Century Cures Act penalizes companies that purposefully block information sharing. However, proving a company’s wrongdoing is difficult, and if a product is allowed to fail, then the hospitals, clinics, and patients who depend on the EHR system will all suffer. For this reason, current levels of punishment and incentives set by the National Coordinator for Health Information Technology are not enough.
Because EHR vendors do not have obvious incentives in enabling information exchange, regulatory bodies must be proactive about mandating compliance. Mandating standards for EHR interoperability by a specific time point–akin to the Environmental Protection Agency’s requirement for automotive manufacturers increase fuel economy standard to 54.5 mpg by 2025 — will light the fire under companies’ feet to ensure that their systems meet the prescribed goal.
Another solution would be to create a single, unified EHR system contracted, ideally, to a private company and overseen by a government body. We already have a working model of this example in the Veterans Information Systems and Technology Architecture (VISTA), a national system developed by the Department of Veterans Affairs that manages the information of 8 million patients. A unified record system will allow easy communication between health care providers, keep patient information safe from market failure — in case one of the major EHR vendors declares bankruptcy or becomes obsolete — and enable powerful population studies that would help physicians devise guidelines and treatments to improve patient health.
After hours of frantic phone calls, we finally connected with a nurse at the outside hospital who gave us the final result: TB negative. We started our planned medications, and our patient improved rapidly.
This story, however, could easily have had a tragic ending.
As it stands, the lack of communication between EHR systems is unacceptable. The government and health care organizations need to push EHR companies harder to play nicely with one another, and soon before more lives are needlessly harmed by corporate reluctance.
Yoo Jung Kim is a medical student.
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