Health systems and physicians are in a unique position when it comes to patient medical records. We need access to the right information at the right time to deliver good care, yet we need to ensure the safety and privacy of those records. Visionary CIO Dr. John Hamalka, refers to this as the “Protect, protect, protect, now share!” problem. Interestingly, as technology has put patient records online and made them more accessible, there is an impression that healthcare providers are avoiding sharing as a business strategy.
In 2005, most medical records were stored in paper files. Access to data by MDs was possible only if they knew the record existed and followed a circuitous path that involved phone calls, faxes, and mail.
Today, almost every American has some data in an electronic medical record (EMR), and 80 percent of physician practices use EMR systems. These EMRs range from simple documentation tools to fully functional software suites that include billing and patient portals.
A catalyst for that growth was the 2009 federal stimulus through which the federal government rewarded hospitals and physicians with $18 billion dollars of incentives for adopting EMRs and using them to increase quality. Unfortunately, the program had few requirements for the ability to share data among hospitals and physicians. As a result, even with the advanced state of EMR use, most data sharing across systems is limited to a short summary of patient medications, history, and allergies. This is a far cry from the seamless flow of discrete data that patients expected given the billions that the government spent. Unfortunately, some federal and state legislators have interpreted this lack of interoperability as “data blocking” by health systems and physician practices.
In fact, there is little evidence that hospitals or physicians are hoarding patient data for their own gain. Quite the opposite is true—after years of building and implementing EMRs, health providers have turned their focus to better data sharing with patients and other providers.
Within my own health system, Yale-New Haven Health System in Connecticut, we have implemented a patient portal which automatically shares most lab results with patients. We offer our EMR software and full access to data to physicians in the community at a subsidized rate. To encourage full access to patient data, we give every physician in our state full and free online access to the records of their patients in our EMR. We have built interfaces for patient data sharing with many physician practices in our community, and we have electronically shared more than 30,000 patient records with 120 other health systems in the US and overseas to facilitate clinical care.
Daniel Barchi
We are not alone in our work to improve the sharing of patient records. Other hospitals and physician practices are also using technology and interface standards to share data locally. Some states and regions have created health information exchanges, and large EMR software companies including Cerner, Epic, Allscripts, and McKesson have either built their own networks for sharing patient data among their customers or collaborated to share some data across hospitals.
Additionally, health providers are incented to act in ways which foster more sharing of data. Compensation is increasingly tied to the quality of care patients receive. Improvement of patient outcomes requires interaction of hospitals, physician practices, and other care agencies; data sharing among them is key.
While data sharing is not easy and has not been a primary focus of healthcare technology players over the past ten years, health providers are actively working to overcome the limits of embedded systems. Innovation is coming at all levels. A company called Apigee is helping providers large and small rapidly accept plug-ins from third parties to export data. My own health system is working to help develop small companies Hugo and PatientBank which help patients download their entire medical records to use or share however they see fit.
Healthcare providers and patient advocates endorse the idea that patients own their data and have the right to expect it will be shared as securely and seamlessly as possible. The healthcare community is actively working to achieve this goal and will continue to do so without additional legislation.
Daniel Barchi is senior vice president and chief information officer of the $4.0B, 2,100 bed, 25,000 employee Yale School of Medicine and Yale-New Haven Health System. He leads a team of 600 informatics and technology specialists and led a $300M Electronic Medical Record (EMR) project.
