Sharing Patient Records Is Still A Digital Dilemma For Doctors
Technology entrepreneur Jonathan Bush says he was recently watching a patient move from a hospital to a nursing home. The patient's information was in an electronic medical record, or EMR. And getting the patient's records from the hospital to the nursing home, Bush says, wasn't exactly drag and drop.
"These two guys then type — I kid you not — the printout from the brand new EMR into their EMR, so that their fax server can fax it to the bloody nursing home," Bush says.
In an era when most industries easily share big, complicated, digital files, health care still leans hard on paper printouts and fax machines. The American taxpayer has funded the installation of electronic records systems in hospitals and doctors' offices — to the tune of $30 billion since 2009. While those systems are supposed to make health care better and more efficient, most of them can't talk to each other.
Bush lays a lot of blame for that at the feet of this federal financing.
"I called it the 'Cash for Clunkers' bill," he says. "It gave $30 billion to buy the very pre-internet systems that all of the doctors and hospitals had already looked at and rejected," he says. "And the vendors of those systems were about to die. And then they got put on life support by this bill that pays you billions of dollars, and didn't get you any coordination of information!"
Bush's assessment is colored by the fact that the company he runs — athenahealth — is cloud-based, and stresses easily sharing electronic health records. The firm also got a lot of the federal cash.
Dr. Robert Wachter, with the University of California, San Francisco, says sure — in hindsight, the government could have mandated that stimulus money be spent only on software that made sharing information easy. But, he says, "I think the right call was to get the systems in. Then to toggle to, 'OK, now you have a computer, now you're using it, you're working out some of the kinks. The next thing we need to do is to be sure all these systems talk to each other.' "
Right now, the ability of the systems to converse is at about a 2 or 3 on a scale of 0 to 10, Wachter and Bush agree.
Wachter is about to publish The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age, a book that assesses the value of information technology in health care. Up until now, he says, there has actually been a financial dis-incentive for doctors and hospitals to share information. For example, if a doctor doesn't have a patient's record immediately available, the doctor may order a test that has already been done — and can bill for that test. Keeping EMRs from talking to each other also makes it easier to keep patients from taking their medical records — and their business — to a competing doctor.
It's time for that to change, says Dr. Karen DeSalvo, the federal government's health IT coordinator. She is stepping in now, setting some standards for how to share digital information.
"The time of letting a thousand flowers bloom, and having a set of standards that are quite variable, should come to an end," she says. "We should be working off the same set of standards."
The billions of dollars a year the government pays to doctors, hospitals and other institutions for patients enrolled in Medicare is a pretty good motivator. Already, Medicare is starting to increase pay to doctors and hospitals that work together to streamline care and avoid duplicative tests, and to penalize those that don't. Winning the new payments and avoiding the penalties increasingly require proving that all of a patient's doctors, no matter where they are, are working together. That requires using good electronic records that can seamlessly move from one system to the next.
Wachter says that consumers are now demanding better health information technology, too — "because we're all used to our app stores and we know how magical it can be when core IT platforms invite in a number of apps."
"So I think," he says, "that even the vendors and healthcare delivery organizations that have been fighting interoperability recognize it's the future."
He says a lot of IT companies are now eager come up with software that meets the demands of the health care industry and consumers. About a dollar of every $6 in the U.S. economy is spent on health care. A new IT boom in that sector means there are billions of dollars to be made.
This story is part of NPR's reporting partnership with Montana Public Radio and Kaiser Health News.
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Transcript
DAVID GREENE, HOST:
Billions of dollars in taxpayer money have been spent installing electronic record systems in hospitals and doctors' offices in recent years. This was supposed to make health care better and a lot more efficient. But federal funding has now dried up and most of the electronic record systems can't talk to each other. Here's Montana Public Radio's Eric Whitney.
ERIC WHITNEY, BYLINE: The other day, technology entrepreneur Jonathan Bush says he was watching a patient get discharged from a hospital to a nursing home. The patient's records were in an EMR, an electronic medical record. He recounts how the patient's information got from the hospital to the nursing home.
JONATHAN BUSH: These two guys then type - I kid you not - the printout from the brand-new EMR into their EMR so that their fax server can fax it to the bloody nursing home.
WHITNEY: Crazy right? In an era when most industries easily share big complicated digital files, health care's still leaning hard on paper printouts and fax machines. Bush lays a lot of blame for that at the feet of the federal government. In 2009, it used the Stimulus Act to offer doctors and hospitals money to buy electronic records systems.
BUSH: And I called it the cash for clunkers bill because it gave $30 billion to buy the very pre-Internet systems that all of the doctors and hospitals had already looked at and rejected, and the vendors of those systems were about to die. And then they got put on life support by this bill that pays you billions of dollars and didn't get you any coordination of information.
WHITNEY: Bush's assessment is colored by the fact that he runs a new generation electronic health records company - athenahealth - that stresses easily sharing information. It also got a lot of the Stimulus Act cash that he says propped up companies making clunker software. Dr. Robert Wachter, of UC San Francisco, says sure, in hindsight, the government could have mandated that stimulus money could only be spent on software that made sharing information easy, but...
ROBERT WACHTER: I think the right call was to get the systems in, and I think that's the stage we've been at for the last couple of years. Then to toggle to OK, now you have a computer, now you're using it, you're working out some of the kinks. The next thing we need to do is to be sure all these systems talk to each other.
WHITNEY: Wachter's about to publish a book assessing information technology in health care. Up until now, he says, there hasn't been financial incentive for doctors and hospitals to share information. They can actually bill more if they repeat tests they don't know about because they don't have a patient's records. And keeping EMRs from talking to each other makes it easier to keep patients from taking their business to competing doctors. It's time for that to change, says Dr. Karen DeSalvo. The federal government's health IT coordinator is stepping in now, setting some standards for how to share digital information.
KAREN DESALVO: The time of letting a thousand flowers bloom and having a set of standards that are quite variable should come to an end. We should be working off of the same set of standards so that we can accelerate.
WHITNEY: And the billions of dollars the government pays out for Medicare and other health care programs is a pretty good motivator. It's starting to increase pay to doctors and hospitals that work together to streamline care and avoid duplicative tests, and to penalize those that don't. Winning the new payments and avoiding the penalties requires proving that all of a patient's doctors, no matter where they are, are working together and using good electronic records to do it. And Dr. Robert Wachter says that in just the past few years, consumers have started demanding better health information technology, too.
WACHTER: Because we're all used to our app stores, and we know how magical it can be when core IT platforms invite in a number of apps. So I think that even the vendors and the health care delivery organizations that have been fighting interoperability recognize that is the future and they have to get on board.
WHITNEY: He says lots of IT companies are now eager to come up with software that meets health care industry and consumer demands. About one in every $6 in the U.S. economy is spent on health care. A new information technology boom in that sector means there's billions of dollars to be made. For NPR News, I'm on Eric Whitney.
RENEE MONTAGNE, HOST:
And that story is part of a reporting partnership with NPR Montana Public Radio and Kaiser Health News. Transcript provided by NPR, Copyright NPR.
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