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If you want to get a furious look from a doctor, ask them about their electronic medical record systems.

Studies have shown that electronic health records are directly attributable to the growing problem of physician burnout due to the time spent filling in fields in these systems for hours, even after a grueling day of seeing patients. Even more troubling, doctors still find it difficult to access medical information about their patients, particularly if that patient has been seen in a hospital or clinic that uses another medical record provider.

This is a problem that could have been resolved years ago.

In 2009, federal policymakers set aside about $ 35 billion in tax revenue to digitize paper systems. The hope was to make it easier for doctors to access their patients’ medical histories with a few clicks. And by moving clinical information from paper to an electronic format, researchers could use this information to better understand human health.

A number of medical record companies blossoming, largely because hospitals needed a provider to manage their patients’ medical information. Rather than building technologies that would be interoperable, many of these companies have built vast empires by hoarding this information.

“It’s almost unacceptable,” said Dr. Julia Adler-Milstein, associate professor and director of the Center for Clinical Informatics and Improvement Research at UC San Francisco, who has been studying the problem for years. “The government has spent billions on digitizing records, but patients still have problems accessing their medical records in 2020.”

Today, in the midst of a major health crisis, physicians still face major challenges in accessing patient records.

When Dr. Vincent Rajkumar, a Minnesota oncologist, hears from a patient who has sought care at a hospital that uses a different medical record system, he knows it will take a lot of work. He will generally work with his patients (who at that time have usually been diagnosed with cancer) to call their old hospital and / or clinics to request the records. These recordings will often arrive in PDF format. Rajkumar will then download them manually, a process that could lead to delays in making vital treatment decisions for his patient.

Many doctors believe that Epic could do more to resolve the problem, but CEO Judy Faulkner told CNBC during the Health Returns Virtual Summit earlier this week, it’s a challenge when other providers don’t want to interact.

Judith Faulkner, CEO of healthcare IT giant Epic Systems.

Source: Epic Systems

Faulkner told Bertha Coombs of CNBC that Epic was one of the “initiators” of interoperability. Faulkner said that in the early 2000s, she had heard of a patient who was treated by her husband – a doctor -. The patient had left his care and had moved to another city. This hospital was unable to access her records easily and she died.

And he (Faulkner’s husband) kept saying, “If they had had his file, they would have known what to do. It was easy.”

Faulkner described the institutional resistance to the powers that be, including the trade associations that oversee the different providers, but said that it had progressed despite everything with an interoperability framework for hospitals using Epic.

And doctors agree that it has become easier to share records with other hospitals using Epic.

“It’s an improvement day and night on this front,” notes Rajkumar, who has worked with Epic systems for several years. “If your patient is from another site that has Epic, I can see everything immediately – even the labs done yesterday.”

Not a problem solved

But the question of the interoperability of medical records is by no means a problem solved.

It is always difficult for patients to move their records freely between systems, and data blocking is still a common occurrence. To combat this, the Ministry of Health and Social Services recently finalized a rule that aimed to make medical records accessible via application programming interfaces or APIs. The ruler is also designed to make it easier for hospitals to share patient records with other medical offices or hospitals.

Epic initially publicly opposed the rule, reporting holes in patient privacy, but the legislation was passed shortly before the pandemic. In a statement, the company said later that it believed the government was “listening carefully” to its concerns and that it would support the goal of “giving Americans control over their medical information”.

Parts of the rule have now been delayed to make it easier for providers in the midst of the coronavirus. Once the bill moves forward, it may take several years for the full effect of the changes to take effect.

Patient groups and advocates have largely embraced this. For them, it is a huge undertaking to request their medical information and transport it in paper bags or on CD-Rom. Before dying earlier this year, serial entrepreneur and cancer patient Leila Janah argued for interoperability of medical records, noting that in her case, she had to go to a cancer conference for all of her oncologists to watch the same source of “fundamental truth”. . “

The ruler is largely designed to make it easier for patients to access and share their own records with a hospital or application developer. But doctors say there is still a big challenge for hospitals to share data with hospitals using any other system other than Epic. Or really so that two different suppliers, Epic or other, connect.

Faulkner noted at the Healthy Returns event that other providers could, in theory, connect to the Epic system.

“We cannot send a fax to someone who does not have a fax machine, so you cannot interact with someone who does not work,” she said. “Well, we were frustrated that we couldn’t interact with a health system that couldn’t interact. So we said, ‘Stop thinking of this as an excuse, they can’t interact and figure out what we can to make them interoperate. ”

Epic has a tool called Sharing Everywhere to allow other systems to connect to Epic, she said. But doctors point out that it remains a big challenge to do this in practice.

“It takes gymnastics to get an Epic system to speak to a non-Epic system,” said Aaron Miri, director of information at Dell Medical School and UT Austin.

Miri said that one of the big challenges remaining is that there is no single number or code to identify a specific patient. So an Aaron Miri in another supplier’s system could be a different Aaron Miri. Understanding this creates a headache for hospitals and delays in accessing records. “It gets very complicated quickly,” he said.

Hospital executives like Miri say they desperately want the situation to change, but this is not yet the case due to financial incentives.

“I think it will continue until there is strong application and some sort of unique way to identify a patient,” he said. “The reality here is that your medical information is big business – and it should be.”

Why is it important

Interoperability gaps are a big problem for doctors. But why is it important for consumers?

Here is a small sample of the problems caused by the lack of interoperability. All of this adds complexity and cost to an already overburdened healthcare system.

  • Doctors often find themselves ordering duplicate tests, which is a problem for patients and a major source of unnecessary costs.
  • Patients may see delays in care as their doctors try to aggregate their medical information.
  • This allows patients to feel trapped in a system, as it is a burden for them to go to another hospital that uses a different medical record system.
  • Sellers of electronic health records may also charge more to their customers, including fees and services.
  • This weighs on doctors, who should be concerned with treating their patients.

When doctors spend time researching medical information, they should be able to access it automatically or they cannot manage the care of their patients properly.

This is particularly problematic during the coronavirus pandemic, when many doctors are overwhelmed with cases and need to quickly access patient medical information.

It also slows public health research, as officials need access to relevant clinical information about Covid-19 patients – not just the report on whether or not they have been diagnosed.

Yet there is reason to be optimistic, say health technologists.

There are now standardized application programming interfaces, or APIs, that the industry has brought together to facilitate the sharing of clinical data with patients.

Dr. Kenneth Mandl, who heads the Computational Health Informatics Program at the Boston Children’s Hospital, has been working on these technology standards for years. APIs, including Fast Healthcare Interoperability Resource, are now integrated into government regulations and are adopted by technology companies like Apple.

They are designed to provide structure and information content for health data as it is shared between hospitals. The goal is to make it easier for developers to create applications that allow access to health data – with patient consent – regardless of the health record system used by the hospital.

“We have at least resolved part of the interoperability problem,” he said. “There is more to be done for it to really work as a system, but with interoperability, we are very far on the right track.”

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