Name: Broken Records: Broken Promises
Uploaded: 2019-03-17
Duration: 6 min 57 s
Description: Years after their adoption, electronic health records still haven't lived up to their potential.

It's now been ten years since the EHR incentive program was created, yet we still do not have adequate levels of interoperability. So we can sequence the entire human genome, but we still can't get much more than a print out, a fax, or CD- ROM when we leave the doctor's office. But often we are delivering care with a fractured medical record. The electronic health record unfortunately was introduced As a halfway technology [ SOUND ] The promise was that everybody in America would be able to have their own personal electronic health record. You would be able to Monitor your health more closely you'll be able to communicate back and forth with your doctor. And for most people that hasn't really happened. The whole goal, one of the major goals of converting paper records to electronic charts was ease of data entry and retreiving data so that this can be shared in a straight forward way. The question is, why is it so hard to get your information? And it's on a computer, it shouldn't be so hard to print and get it. Interoperability is the term the industry uses for do these systems Communicate with each other, can they share health data with each other. And right now we're trying to get to a very basic level of interoperability which is to send and share very basic data sets. The idea that all the information in one system Can be shared with another is a long ways off. The idea of interoperability is to have sort of a seamless national system in which health data can be shared by vast quantities. Both for the treatment of diseases and for the ease at which you can have your records sent, or someone can send the records on your behalf. That could save your life. The inoperability problem is one that's been more intractable than I expected. And so, I think we probably should have thought about ways at the beginning, require it at least for some aspects, for safety to require it because the economic incentives are such says that it's really hard to make that happen on it's own. We have hundreds of different electronic vendors in this country. And they often all operate independently. Why should Epic, this huge company, have to share its information with BMR2 or whatever you wanna call this local one? Historically, there have been a lot of proprietary coding systems that were built as part of products. There are about five or six well- known companies, all of whom Invested millions and millions of dollars trying to get that information correct, and that knowledge is propietarian and they rightfully don't wanna give it up. While most doctors offices and hospitals have gone paperless, and they use electronic records, those records are not shared or integrated with other facilities. Essentially whereas your information was in a filing cab but now is in an electronic filing cab. So, we don't have a system where data is traveling seamlessly with the patient as they go through the healthcare system. Hospitals don't want their patients to be able to go across the street for competitor really easily. And so, they make their computers not share all the information because they don't want the patients delete. When I first started in this role, I think I had this naive expectation that all of the information that I wanted and needed to properly take care of patients would be available to me in an easily accessible formats. It didn't take long before I figured out that's not all the case. In order to get information about our patients we need to do a lot of slew thing and a lot of light work and a lot of obtaining outside records and information. And that process can be very cumbersome and it can take a long time. There were so many very quick installations of this equipment to recoup this stimulus money, there were doubts and questions, and still are questions whether, in fact, the requirements were being met by some of these vendors. Very careful checks have to be done to make sure that the patient safety checks are operating properly. If I've got data coming in from another system and there's something wrong in that data, that's misinterpreted in my system. Now all of the fancy clinical decision support systems that I just spent huge amounts of money and time on are gonna misfire. And it's either gonna not tell me to do something when it needs to, or it's gonna tell me to do something when I shouldn't. And you know, that's dangerous. You could kill somebody. There's been a lot of examples in which the electronic health workers have mixed up patients and put information about one patient in the wrong file. You get other situations in which doctors order a test and then by some kind of a software glitch it disappears before it gets sent to the lab and so. The doctor could be waiting around for test results and not realize that the test never got to the lab. So there are a couple of important things that need to happen to improve EHR's building and safety. So the first one is, we have to have more effective EHR usability and safety testing. The second important pieve is that Many of the contracts that exist between EHR vendors and provider organizations, healthcare provider organizations, contain language that are often termed gag clauses. That prevent the open communication and sharing of usability and safety challenges There's just been a culture of complete secrecy in this industry. Which has prohibited a lot of people from honestly talking about the problem ,. There's confidentiality clauses that say pretty threateningly that, you're not to share any information about how much you paid this system, about any problems you see with this system and You can't really call your buddy at another hospital and say we installed such and such system and man it's garbage. The companies say thejy're protecting intellectual property but many safety experts say this really is preventing widespread learning on the safety risks. The driver of everything. The most important person in this entire story is the patients. And just like doctors and nurses should have access to all of their information in a way that they can make informed healthcare decisions, patients need access to their own information too, so they can manage that properly, bring it to other providers, or just have it for their own sake and their own knowledge. If we could somehow find a way to put the patients first. Then the opportunity is there. Because if everything is recorded, and everyone listens to flags and warnings, then they'll catch things we can't even dream of. And that's fantastic. [ MUSIC ] [ BLANK_AUDIO ]

Broken Records: Broken Promises

Health

Years after their adoption, electronic health records still haven't lived up to their potential.