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Barriers to the Exchange of Medical Records

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Jim Rowland
June 10, 2015

I read a recent New York Times article by Robert Pear, and as I sat at my desk, I felt that I needed to post a response.

The article points to a facet of the problem facing the sharing of medical records: holding on to customer data and not sharing it with competitors is standard business in most industries. This can most certainly be applied to clinical data in the healthcare industry as well; however, it is now illegal to do so, and there is enough of an enforcement threat that I don't see this business practice as a barrier for the exchange of medical records going forward.

Yet, the main point of the article, which is that clinical records are not effectively being shared between providers (to the surprise of patients), simply needs to be addressed. There has been far too much invested to abandon the last mile.

To clarify this issue, one needs to first be aware that sharing healthcare data is very complex, and must be looked at from two separate perspectives, that of healthcare system administration and the providers themselves.

1. From the healthcare system administration point of view (as the article explains), many technical advancements need to be set into place to allow systems to cost effectively exchange clinical data. The customers of EHR companies (health systems and private practices), on the other hand, are not applying enough pressure to make this a top priority, because there is so much work that needs to be done within EHRs to make them more usable, efficient and compliant with their increasingly difficult certification standards.

2. From the provider perspective, let me list just a few of the challenges:

  • The tools for sharing the data may not be available in a given practice environment, and the best a practice can do is print the record, which is a large burden, making the data digitally unavailable.
  • Doctors are afraid of data they did not collect, they cannot accept it on face value. They don't know its context, its accuracy, its current validity. In addition, doctors don't have the time to review it, nor would they be reimbursed for their effort. Thus, they fear the potential liability of data which they cannot review, but could actually contain damaging information leading them to unwarranted liability in a malpractice case. This leads many doctors to prefer not to receive data beyond summaries from other providers outside of their system.
  • Older doctors are used to making notes to themselves in patient charts which were not meant to be shared, and now these notes are part of the record that could be shared, comments such as "this 68 year-old, cranky and unfortunate man presents with a right pelvic fracture...."
  • Some providers are concerned with the potential results of being bench marked against their peers after the data is aggregated and compared.

We will need to address all of these issues with adequate legislation, education, and software, for both the provider and the consumer, with the proper incentives as drivers for change. The Accountable Care Organization (ACO) model with pay for performance incentives to health systems is becoming the leading incentive for clinical data to be shared. An ACO needs to report on its aggregated quality of care measures across a whole population, forcing clinical data to be shared within the ACO, and practices are reimbursed for keeping a population healthy rather than the prevalent fee for service model.

In order to keep a population healthy, you need to share and make sense of all the data available, so data sharing becomes the norm. The ACOs are becoming a driver for the exchange of medical records, and software designed to meet these needs is being developed and implemented. Healthjump is working on these specific problems, as well as building the capability for the patient to be in the middle of this data flow.

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