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Electronic Health Records and Patients' Wallets

August 13, 2010
by John DeGaspari
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Since the release of the final meaningful use rule last month, much attention has focused on the ability of heath providers to meet the benchmarks under the HITECH Act. And rightly so: hospitals have plenty of work to do before bringing management of their electronic health records (EHRs) into the 21st century.

It’s important to keep in mind that meeting the final rule’s requirements is not an end in itself. As noted by National Coordinator for Health Information Technology David Blumenthal, M.D., in the announcement of the final rule last month, “Adoption of meaningful use of EHRs will help providers deliver better and more effective care, and the benefits for patients and providers alike will grow rapidly over time.”

I hope so. The recent experience of a friend of mine, let’s call him Tom, illustrates how far even large hospitals in one major metropolitan area, New York, have to go in streamlining their EHRs—and how patients get penalized, both in the quality of care and financially, for the inefficiency of the health provider.

Following a regular physical examination, Tom’s doctor, who practices in a large, well-known hospital in Manhattan, recommended that he undergo a CT scan and referred him to a gastroenterologist practicing in an even larger, better-known hospital in Manhattan. Tom duly made the appointment with the specialist, and asked the hospital to forward the test results to the second doctor. The hospital made a copy of the results on a CD and had it delivered via FedEx to his home—at a cost of $50.

More surprises were in store. When Tom went for his appointment at the specialist and personally delivered the CD, that doctor could not open the file to view the results—after trying to open it on two different computers in his office. He then told Tom that he wanted him to undergo an MRI. Tom is now thinking about going to a different gastroenterologist, hopefully one that is more computer savvy.

Apparently, size doesn’t necessarily matter in the quest for more efficient EHRs. Even some very large health providers use the equivalent of the Pony Express to deliver patient records. More to the point, it demonstrates the difference that truly networked EHR can make, both in cost saving and in the quality of care that every patient has a right to expect.

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Comments

John,
You made a number of important observations about policy, process, interoperability, and connectivity, as it relates to achieving better and more effective care.

I'd like to react to the transportable physical media aspect. If we're going to keep it electronic (i.e. avoiding printing it paper as we routinely do today), that means CDs and thumb/USB drives.

At a leading national conference last week, Charles E. Christian, FCHIME, FHIMSS provided the General Session Keynote Speech. He has been a highly successful and accomplished Healthcare CIO for about twenty years, connected to two successful and well known HIE's in the Indianapolis area.

He shared a recent story about sharing a presentation with an audience member who, like everyone else at the conference, was carrying one of those thumb/USB drives. Long story short, the drive when placed in Christian's machine quietly, auto-loaded a virus. Before that was apparent, it made it's way through the same mechanism to his office PC when he returned home from that conference.

So, recent experience strikes again. In this case, the proven solutions range from caulking shut the USB slots on public machines (not making this up although not Christian's solution), disabling the auto-load / auto-start capability, or, as you suggested, re-double our efforts to achieved truly networked EHRs. 

There are, of course, other reasons to block users from connecting and use of USB storage devices.  Here's a knowledge base article with one solution.

All we'll have left to do then is convince your friend Tom that those tnEHRs are as trustable, i.e. private and secure as physical media (CDs and thumb/USB drives)!

Thanks for your post. You brought up the issue of the true costs of one route to MU that's in practice in NYC today.

I read your article, and it is really informative. I am happy, that you are also thinking more about the patient rather than the hospital. It is necessary that each patient has their own medical record that they are able to carry everywhere. I would like to tell you that we develop the same EMR but we name it as "Patient Medical Portfolio." It is both Web-based and a standalone entity. Whenever the patient goes to a doctor for any reason, he gives his Portfolio (which is in a thumb/USB drive), which contains his medical history. The USB drive contains two passwords: a public password for the doctor and a private password for the patient. Depending on the type of visit, the patient can use his password to show medical history. Similarly, the doctor can add new medical information (treatment details, lab test, advice) to his portfolio. It is also a Web-based program, so we can add online records to the portfolio. The patient can maintain his portfolio at home, so he can write his daily health information about his blood pressure, blood sugar, which helps the doctor review the patient information. As it contain two passwords, it is safe, and nobody can see the patient's data or misuse it. It is a really good concept from a patient point of view and can help him in emergency without any paper work.
Shripad,
Health IT Professional.
India.

John,
Great point, I had a similar situation a year ago. In my case the specialist sent over an elec file to my GP. Being an healthcare IT person for over 30 years before I left the specialist I asked for a hard copy of the report, right after the specialists told me he would transmit the results file to my GP.

When I got to the GP's office the next day, after watching his staff struggle to open the file for 10 minutes, I handed them my hard copy.
They said 'thanks'...

And as for Joe's thumb drive suggestion, nice idea but you can run into the same problem because you really should encrypt the data on the drive in case it falls into the wrong hands. Then you have to make sure others who are authorized to access it have the right de-engryption tool, algorithims and know the security codes, etc. ...or your in the same boat as before.
Frank Poggio
The Kelzon Group

John DeGaspari

Managing Editor

John DeGaspari

www.healthcare-informatics.com

John DeGaspari is a journalist with more than 20 years of experience reporting and writing about...