Electronic Health Reporter

Guest post by Joseph Wager, senior risk management and patient safety specialist, Cooperative of American Physicians, Inc.

With the mandate of electronic health records (EHR) across the nation, hospitals and physicians are researching, evaluating and purchasing EHR Systems. These systems range in price from affordable with minimal investment to the Rolls Royce version.

Many hospitals are investing large capital dollars for EHR programs. Hospitals must choose a vendor that will meet the organization’s needs. Physicians may choose systems that are more narrowly focussed to the needs of their offices and their specialization. In other words, interoperability may be addressed for hospital EHR systems with their more diverse internal users and may not be a major consideration for a non-network physician. Even with anEHR system in place, they do not necessarily make information sharing easier since many of them do not have interoperability outside of their networks.

Traditionally, hospitals and physicians do not share patient information with other hospitals and other physicians. Hospitals may fear that competitors will market directly to their patients and allow patients to gain privileges at their competitors’ facilities. Specialists may not share records with primary care physicians on a regular basis.

Hospitals and physicians may be reluctant to allow access to patient records for fear of exposing possible HIPAA breaches and incurring fines related to such breaches. To avoid these fines, greater attention is paid to limiting access to patient records to only those with a need to know.

Another possible reason for reluctance to share patient records relates to possible errors in data input or omissions in data entry that might expose a hospital or physician to scrutiny from outside their facilities. Controlling and monitoring data input means that the records are only as good as the person who inputs the data at the time of the visit, which should be completed on the date of the visit.

A third possible reason for reluctance to share patient records relates to fear of reprisal from an insurance company regarding preexisting conditions. Sensitive medical information (e.g., HIV positive status, hypertension, diabetes) found in a patient’s records might adversely affect his ability to obtain medical insurance. As HIPAA rules keep changing, it is not certain that patient rights are always in the forefront.

Even with these reluctances to sharing patient records, there are important reasons to share data. In emergency situations where patients can not speak for themselves and it is not possible to reach the primary care physician, access to EHR data can save the patient’s life. Also, emergency room access to a patient’s medical history may reduce frequent short-term admissions and readmissions. For example, review of a patient’s medical history may define the course of treatment when he complains of chest pain but has a documented long-standing history of hiatal hernia. Recently, the Medicare program has been chastising hospitals and subjecting them with penalties for having high readmission rates.

As federal “meaningful use” criteria are rolled out for hospitals and physicians receiving Medicare and Medicaid reimbursements, interoperability is required for a “certified” EHR system. Interoperability is defined as the ability to communicate with and transmit healthcare data with other software. This standard concerns an obligation to the patient concerning their patient records and not necessarily an obligation to share that information with other healthcare providers and hospitals.

Regarding the federal government’s own record-keeping, the Veteran’s Administration has created its own medical record system. They have budgeted billions of dollars for the enhancement of this record-keeping system in the upcoming year. The system will allow sharing of patient healthcare information with the Social Security Administration, U.S. Department of Defense and other health care providers, but who those healthcare providers are and what patient information will be accessible remains to be seen.

In conclusion, interoperability of patient records may benefit physicians and hospitals who need to know how to better treat the patient using medical data that provides them with a written history of the patient. Such data obtained in an electronic format makes access faster and more comprehensive.

Reluctance to provide such data may exist, but patient needs can overcome trust issues among healthcare professionals and institutions. Going forward several questions must be addressed:  (1) Can one mega vendor provide a standardized technological communication language? (2) Would this vendor be able to create common standards for sharing and moving data for all users? (3) Will making patient data easier to share encourage physicians to be more willing to share data? (4) Will the federal and state governments openly share their data with healthcare providers? And (5) will someone be overseeing the process or will self-governance be enough?

Joseph Wager, senior risk management and patient safety specialist, Cooperative of American Physicians, Inc.. Wager has been in the healthcare profession for the past 30 years. For more than a decade, he worked several positions with Kaiser Permanente: Assistant Medical Group Administrator; Department Administrator of Family Practice, Urgent Care and Pediatrics After Hours; Assistant Department Administrator for Respiratory Care. He began his healthcare career as a Respiratory Care Practitioner at Hollywood Presbyterian Medical Center.