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EMRs are great…but have they sucked up all the oxygen for care innovation?

For twenty years, the Holy Chalice of medicine’s future was thought to be Electronic Medical Records. The air was filled with the potential wonders of electronic data sets that would track a patient’s health over time and improve the quality of care. In 2004, President Bush set as a goal that every American would have an electronic health record by 2014.  President Obama signed the HITECH Act in 2009 providing a huge federal stimulus to the adoption of electronic medical records.

After spending over $35 billion in federal funds and much more than that in state and private funds, we have pretty much achieved Bush’s goal of having an electronic record for every American. In fact, there are many, many electronic records. Practically every hospital, health clinic and physician’s office has an electronic record. Personally, I assume I have around fifteen EMRs strewn throughout three or four states. Of course, none of them communicate with the other. Despite having never been hospitalized and in fairly good health, I have records with primary care, urgent care and specialists as well as pharmacies, health insurers, etc. Even within a health system the problem continues. Over the past couple of years my wife and I have seen a couple of specialists connected with Inova Health, the same system we have used for our health needs for years. Even though the system is interconnected, and we are assured that they have our payment and insurance records, we still have to fill out, by hand, the same multiple sheets of paper asking the same list of questions.

The common belief is that health records should reside with the primary care provider (PCP). This is a noble goal. The problems with this are many:

  • At least 20 percent of the population has no PCP.
  • Patients with a PCP see them far less often. Instead, they use emergency rooms, urgent care and online care for primary care services without any knowledge of their physician and no record of their visits transferred.
  • Almost half of the population change PCPs within 5 years (due to change in location, insurance, and preference)
  • The amount of patients maintained by PCPs has grown significantly and the amount of time spent with patients has shrunk. Several studies have recommended that a PCP maintain a patient load (panel) of about 1,000 patients but most have around 2,500
  • Unless pressed by the patient, providers rarely share the patient’s medical records, regardless if they are paper or electronic
  • Nor, do they share the information with each other. A study from the Archives of Internal Medicine (via the WSJ’s Health Blog), found that “that while more than 69% of primary-care physicians said they always or mostly passed on a patient’s history and reason for a consultation to the consulting specialist, fewer than 35% of specialists reported always or mostly receiving that information.”
  • Individual institutions may have their own proprietary medical record but it is hard at best for a patient to transfer them out of the institution and impossible to collect all the disparate information from the multitude of medical services and products that one encounters in life. I’ve known a lot of sick people but I have yet to find one that has successfully pulled their information from multiple EMRs and put it in one place. 

Meanwhile, telemedicine, digital health and related innovations that focused on patient care have been met with a policy I call Enforced Disregard.  “Not enough evidence;” “a danger to patient safety;” “a cause of higher utilization and higher costs” were a few of the retorts to appeals for coverage. Harrumph!

Instead, pilots and research projects were funded to explore the potential of telemedicine, which effectively delayed actual deployment and reimbursement until another day – what I called hitting the snooze button. If you don’t want to do it - fund a pilot.

Two conclusions:

  1. Let’s face reality. The only way we can make effective use of medical records is to have them centrally and independently located and owned by the patient, not a physician, health system, payer or pharmacy
  2. The sad fact is that with the billions spent on duplicative medical record systems there has been very little spent on improving the way care is delivered. Medicare has spent almost nothing to support technological innovations in providing medical services while spending billions on EMRs. Isn't it time we try something different?


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