Making electronic health records portable and shareable should be easy. What’s standing in the way?

By Clifton Leaf
October 9, 2017

I can’t remember the first time I used my ATM card to get cash out of a machine that wasn’t part of my bank’s branch network. Could it have been as far back as the 1980s? In any case, I’m sure I complained at the time at the outrageous $1 or $2 “not-our-bank-so-shove-it” charge that was tacked on to the transaction. (The fees, of course, are now as high as $3 in some places, and perhaps I’ve paid even more.)

But such annoyances aside, there is an underlying achievement in this that we now take for granted: We can get our money anywhere. I have withdrawn euros in Rome, krona in Stockholm, pounds in London, and dollars across our American landscape—all deducted from my own bank account. I’ve gotten cash from standalone ATMs in delis and drugstores, groceries and gas stations. In each case, the remote ATM communicates with a network (or more than one network), confirms with my bank that I actually have the money I want to withdraw, deducts that amount from my ledger, figures out what sort of transaction fees ought to be paid to whom, and then dispenses the cash.

This is such a part of our daily routines that it sounds almost silly to spell it out. And yet, remarkably, the same thing—a secure electronic handshake between computers on different networks—seldom happens in our health systems. The first electronic health records (EHRs) were developed in the 1960s, and yet, more than a half-century later, many of them are still not interoperable.

Indeed, a new study in the journal Health Affairs, by A. Jay Holmgren, Vaishali Patel, and Julia Adler-Milstein, found that fewer than 30% of the 3,538 American hospitals surveyed could interact with other medical systems on four key “domains” of EHR interoperability—finding a patient’s records, sending them electronically and securely to another medical institution, receiving new patient data, and integrating that information back into the patient’s electronic record. The research team also tracked progress on this front between 2014 and 2015 and found that EHR integration efforts were “substantially slower” than in the previous five years. In other words, whatever policies are in place to catalyze this effort, they ain’t working.

And it’s not just hospitals where such interoperability is essential—and lagging. As HIMSS (Healthcare Information Management Systems Society) frames it: “Data exchange schema and standards should permit data to be shared across clinician, lab, hospital, pharmacy, and patient regardless of the application or application vendor.”

Sure, it’s sensitive stuff—and having it land in the wrong hands would be scary. But then you could say the same thing about your cash.

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