As if the global coronavirus pandemic was not difficult enough, US clinicians and policymakers are facing another obstacle to Covid-19 research– our fragmented electronic health record (EHR) system. EHRs have the potential to give researchers and policymakers rapid access to information on Covid-19 patients, telling us who is more likely to be infected or die from the virus, how the virus interacts with other chronic conditions, and which treatments appear to work better than others.
However, as Fred Shulte recently reported in Kaiser Health News, gathering EHR data from hospitals across the country “has proved a technical nightmare thus far” because health records built by rival EHR companies are not “interoperable”–they cannot retrieve and share information across EHR systems.
Rather than create a national network of health information exchange on a publicly-maintained electronic medical record system, in 2009 the government endorsed a “regional” approach for building EMRs. As a result, in many regions of the country it is no easier to share medical information than it was a decade ago.
For example, just a few weeks ago, patient advocate Stacey Hurt shared an anecdote on Twitter: After she had a PET scan, her oncologist asked for it to be burned to disk and overnighted to her surgeons–in the same city–so they would be able to look at it. This seems crazy in 2020, but in many hospitals, it’s where we are at.
I had a PET scan today and my oncologist needs it burned to disk and overnighted to my surgeons right here in Pittsburgh to look at it 😳 How are we doing here? 🤦🏻♀️ #Interoperability #ptexp #digitalhealth #HealthTech #telemedicine #TelemedNow #healthcare #HealthIT #cancer pic.twitter.com/fqJDSZjcq1
— Stacy Hurt (@stacy_hurt) May 12, 2020
Like so many other aspects of our health care system, the pandemic has laid bare the flaws in EHRs: their inability to deliver information to other providers, the lack of a national database of records, even the difficulty in filling out necessary forms electronically.
Although government agencies have moved to introduce new interoperability standards, mandating that all EHR systems use the same interface and make health records available to patients on mobile apps, these rules have been pushed back since the pandemic began. Even when they are implemented, these new regulations will likely not go far enough in connecting the disparate segments of health information.
In a Health Affairs blog last year, Dr. Michael Hochman, associate professor of clinical medicine and director of the USC Gehr Family Center for Health Systems Science, Dr. Edmondo J. Robinson, chief transformation officer and senior vice president at the Christiana Care Health System, and Lown staff member Judith Garber, proposed a radical departure from our current fragmented system. They advocated for the creation of a national health information exchange public option, to which any health care system can opt in.
Whether a national health information exchange or new interoperability standards, big changes are needed in the health information space–not just to propel new research in times of crisis, but to make it easier for clinicians to practice on a daily basis.