The photo says it all. The green notebook and pen represent the latest and greatest health IT innovations used by the hospital nurse to record my wife’s health information in the hours before her surgery to re-attach a fully torn Achilles tendon (apologies for the cheeky intro and to my wife and anyone else for any HIPAA violations I may have committed in the capturing of this image). It’s not that the hospital does not have an electronic health record. They do – from a vendor widely considered a leader in the industry. Same goes with the physician practice where she receives all her care and where her surgeon and primary care doctor are based. They too have an EHR from another leading vendor. The problem: These systems are not connected. Thus confirming the not so surprising news that health data interoperability has yet to make its debut in our corner of the NYC burbs.
Fortunately for my wife, she is well on her way to recovery (a bit more reluctant to juggle a soccer ball with her son at airports, but nevertheless feeling much better…and mobile). By everyone’s estimation – hers, mine and her surgeon’s – she received high quality care. What’s more, we feel the overall patient experience at the hospital was quite good. That said, I cannot help but ask myself a series of ‘what ifs?’ What if…we forgot to mention a medication she was taking and there was a bad reaction with medication they administered as part of the surgery or afterwards? What if… the surgeon couldn’t read the nurse’s handwriting? What if the next time we go to the hospital, it is a visit to the emergency room and the attending clinicians have no ability to pull any of my family’s health records and we are not exactly thinking clearly enough to recall details related to medical history?
So here we are in 2014, the year that was, until recently, going to be the year when providers start earning incentives from the federal government for demonstrating their ability to electronically share health records with other providers using different EHRs (under the federal government’s incentives tied to Meaningful Use of electronic health records). My personal experience in these matters has certainly been meaningful, but not in a good way…first with my father and now with my wife.
And here’s the aspect of this that I can’t quite wrap my head around. It’s not like we are talking about competing health systems. My friend Zina Moukheiber has raised this issue in some of her outstanding reporting on the topic of interoperability and health information exchange – i.e., how HIE is held back by competition between health systems as much as if not more than barriers related to technology. Our physician practice is one of the largest in our area with over 300 physicians. And while not technically part of the same health system as the hospital, it is affiliated with the hospital and drives what I have to assume is a tremendous amount of referral business. Did I mention that the hospital is literally across the street from the her doctor’s office? So why then are these two provider organizations and their EHR systems not connected? Is it just a question of technology? The simple answer is… it’s not clear. Although there appears to be no formal agreement between the vendors involved – one with a long-standing history and large footprint in acute care settings and the other with a similarly large user base in ambulatory settings – there do appear to be providers that have made some level of connection.
The good news is that recent developments have paved the way for both EHR systems to connect over a leading nationwide network. No doubt about it. No gray area. These systems can connect and share health information. So now it would seem to be a question of commitment and timing by the leaders of both organizations. If I or members of my family are unfortunate enough to make another trip to the hospital in the next year, I will be sure to report back in the future on what I hope is a story of progress (and speedy recovery towards good health).
So what has been your experience with your local providers? Are clinicians at your hospitals and doctors’ offices still using three ring binders, pens and paper to capture your health information…with you acting as the source? Or has all your pertinent clinical data already been electronically communicated and integrated into the providers EHR in advance of your visit?
It has been great seeing everyone in Orlando!
This piece was also shared on The Health Care Blog.