Guess who owns your healthcare data? NOT You

American Council on Science and Health – The portability of today’s patient’s electronic medical record is not anywhere as easy or transparent as copying the chart, handing it to the patient and letting them take it to a new provider – a 1980 technology.

It turns out that unlike analog records, digital records stored in proprietary formats are not easily shared – despite the explicit statement in the federal funding of EHR [electronic health record] systems that they “Improve care coordination, and population and public health.”

Software companies that acquired millions of taxpayers’ dollars to develop proprietary software and then additional millions for the “rent” of annual maintenance and upgrades dragged their feet in creating translators allowing information to pass seamlessly between health systems and physicians using different EHRs.

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When care is “transitioned,” from one physician to another, or from hospital to a post-discharge nursing facility medical mistakes concerning medications and continuing treatment occur, threatening patient safety and health outcomes.

After all, if you are hospitalized and then discharged home, what records does your primary care provider receive about your hospital stay? Does she know of medication changes?

Thirty plus years, billions of dollars and countless wasted hours of physician and other providers time later and we still cannot duplicate let alone improve the 1980 approach.

You would think that these titans of software, with revenues in billions of dollars, would be able to provide a mandated system requirement to share information between providers.

The current excuse for lack of transportability – the Stark law, specific federal anti-trust regulations.

Stark Laws

This legislation written last century prevents ‘kick-backs’ between referring physicians or entities.

The Stark laws are designed to prevent Dr. A from referring a patient to Dr. B and receiving some financial remuneration or from referring that patient to Lab or Facility C in which Dr. A has a financial interest. Read more.  COVERAGE CONTINUES BELOW … 

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Electronic health record

An electronic health record (EHR), or electronic medical record (EMR), is the systematized collection of patient and population electronically-stored health information in a digital format.

These records can be shared across different healthcare settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges.

EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.

EHR systems are designed to store data accurately and to capture the state of a patient across time. It eliminates the need to track down a patient’s previous paper medical records and assists in ensuring data is accurate and legible. It can reduce risk of data replication as there is only one modifiable file, which means the file is more likely up to date, and decreases risk of lost paperwork.

Due to the digital information being searchable and in a single file, EMRs are more effective when extracting medical data for the examination of possible trends and long-term changes in a patient. Population-based studies of medical records may also be facilitated by the widespread adoption of EHRs and EMRs.

Terminology

The terms EHR, electronic patient record (EPR) and EMR have often been used interchangeably, although differences between the models are now being defined. The electronic health record (EHR) is a more longitudinal collection of the electronic health information of individual patients or populations. The EMR, in contrast, is the patient record created by providers for specific encounters in hospitals and ambulatory environments, and which can serve as a data source for an EHR.

In contrast, a personal health record (PHR) is an electronic application for recording personal medical data that the individual patient controls and may make available to health providers.

Comparison with paper-based records

The increased portability and accessibility of electronic medical records may increase the ease with which they can be accessed and stolen by unauthorized persons or unscrupulous users versus paper medical records, as acknowledged by the increased security requirements for electronic medical records included in the Health Information and Accessibility Act and by large-scale breaches in confidential records reported by EMR users. Concerns about security contribute to the resistance shown to their widespread adoption.

Handwritten paper medical records may be poorly legible, which can contribute to medical errors. Pre-printed forms, standardization of abbreviations and standards for penmanship were encouraged to improve reliability of paper medical records. Electronic records may help with the standardization of forms, terminology and data input. Digitization of forms facilitates the collection of data for epidemiology and clinical studies.

EMRs can be continuously updated (within certain legal limitations – see below). If the ability to exchange records between different EMR systems were perfected(“interoperability”) it would facilitate the co-ordination of health care delivery in non-affiliated health care facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.

Emergency medical services (pre-hospital care)

Ambulance services in Australia, the United States, and the United Kingdom have introduced the use of EMR systems. EMS Encounters in the United States are recorded using various platforms and vendors in compliance with the NEMSIS (National EMS Information System) standard. The benefits of electronic records in ambulances include: patient data sharing, injury/illness prevention, better training for paramedics, review of clinical standards, better research options for pre-hospital care and design of future treatment options, data-based outcome improvement, and clinical decision support.

Automated handwriting recognition of ambulance medical forms has also been successful. For example, Intermedix TripTix offers handwriting support across all elements of the NEMSIS 3.3.4 and 3.4.0 standard as well as custom forms on Windows devices.

These systems allow traditionally paper-based medical documents to be converted to digital at the time of entry with substantially less cost overhead. The data can then be efficiently used for epidemiological analysis, including de-identified data at the National level.