Last week, I had lunch with an old friend who is, by his own definition, technologically ignorant. While we caught up, he asked me to explain in terms he could understand what I do for a living. I went through one of my spiels (the one usually reserved for relatives who only know that I work “with computers”), delivering a high-level talk about systems integration and ETL and some of the challenges involved in intersystem communications. Since most of my time is spent in the healthcare sector, our discussion wrapped back around to healthcare data integration and the initiatives to integrate personal health data electronically across platforms and providers. My friend, being a non-technologist and an outsider to the healthcare world, asked a revealing question:
“So, you’re just talking about lining up the different fields to make sure that they match? If so, what’s the big deal?”
Alas, if only it was that easy.
There is a great deal of noise surrounding electronic health records right now, and for good reason. Everything is electronic these days: my local grocery outlet can analyze my purchasing history to generate customized coupons at check-out; local law enforcement systems are integrated with auto insurers which allows officers to immediately verify insurance coverage; my local dealership tracks my Explorer’s mileage and, based on my estimated milestones, automatically sends me reminders to change my filters and have my transmission checked. Common sense would dictate that our healthcare systems would have at least as much capability as the local Ford dealer, but in practice it seems that this isn’t the case. A visit to the local clinic often requires that I provide the same information several times at various points of care, and this drill must be repeated at each encounter. My family doctor is unaware of any information gathered or treatment performed by my podiatrist, and vice versa. Further, and most irritating, is that a single doctor visit or trip to the hospital will generate a handful of different bills from numerous entities, which often cross over and bill several times for the same specific procedure.
While it may sound like there’s a real dysfunction with healthcare information systems (HIS), the truth is that the situation is not as bad as it appears. I’ve dealt with some outstanding HIS products, and, while they all have their quirks and shortcomings, many of them are mature and highly stable. In my analysis, there are two key issues that cause the most headaches: lack of adoption and system interoperability, each of which bring along their own problems and opportunities. I’ll discuss each of these in turn in the next 2 posts in this series.
As an aside, it’s clear that the electronic health record challenge is not new. I recently developed a networking friendship with a retired physician who spent several years as a hospital chief of staff, and he tells me that he was providing counsel to EHR vendors almost 25 years ago. Even though the issue of electronic health records spans the generations, it’s still a very exciting time to work in this field because of the challenges and opportunities to be a part of some creative solutions.
In my next post on this topic, I’ll discuss the issue of technology adoption, and talk about when an electronic record really isn’t.