We know that “Fix the Damn Roads” is a critical imperative for one of Michigan’s gubernatorial candidates – and hopefully both. But is “Fix the damn interoperability problem with electronic health records” another? The intersection of healthcare and politics is obviously not new. I would contend it’s more visible – and vicious – than ever. Still, the focus tends to be on access to care and delivery of care, and I understand that. Interoperability of EHR hardly pulls at the heartstrings or incites passionate conversation from either side of the aisle; accordingly, it doesn’t garner much attention from the consumer media either. That is why it is important for healthcare decision makers to individually and collectively raise awareness of the issue, not just in the healthcare community, but with our elected officials.
To make sure we’re clear on the topic (and in case some politicians are reading this,) interoperability in this context refers to the ability to share and interpret patient data and information electronically across systems and devices among hospitals, insurers, clinics and private practice physicians.
I’ve said it before, and I’ll say it again: there ought to be a law. While I disdain the proliferation of excessive laws that seemingly aim to control our every move, legislation embraced by both parties to establish requirements for the interoperability of individual health care records is critical element of health reform. It empowers both patients and their providers to get sensible, timely care without excessive testing, over-testing and re-testing. It is patient-focused and cost conscious, while consistent with population health goals.
If I’m hospitalized and then transferred to another hospital, the assumption is that my records will be immediately available electronically to the receiving hospital. Let’s also touch on emergency room or urgent care activities. These “urgent” encounters become part of the patient’s permanent health record seamlessly. Right? Similarly, if I had an ultrasound done at hospital “X” last year, the ultrasound results should be available online, with my permission, at hospital “Y” this year, correct? The response to all these scenarios is, “Not necessarily”. Similarly, unless a physician practice uses a registry or an EHR that “speaks” to a data repository, health plans are also forced to send auditors to the provider to extract much needed HEDIS information, which can get needlessly complicated when the physician doesn’t use a registry at all. (Yes, some physician practices still rely on paper documentation.) Why is this lack of patient data transfer acceptable in 2018?
Surprising to many, interoperability also plays a role in chronic illness surveillance and treatment. Among our organization’s patient population, primary care physicians have dramatically increased compliance with diabetic patients for retinal eye exams, thanks to the affordability of a mobile eye scanning device that allows the scan to be taken in the PCPs office. The scans are then immediately sent electronically to a retinal specialist for interpretation; a referral to a local retinal specialist is provided when merited.
Despite multiple state-wide initiatives in recent years to make interoperability a reality, including those spearheaded by state agencies, none of our collective efforts have moved the needle far enough. Rather than getting all the players to the table to discuss interoperability, new silos are being created to mask communication inefficiencies. Maybe legislation would help us finally achieve the goal?