There has been substantial discussion about electronic health records (EHR) recently, much of it revolving around the application of stimulus funding to support implementation. But the real issues surrounding deployment make funding the simplest step of all.
A successful deployment of a fully integrated EHR/EMR (electronic medical record) system for U.S. citizens would have benefits, but much of what is being discussed falls short of the rhetoric on the nightly news, in articles, and on blogs. For instance, the Health Information and Management Systems Society (HIMSS) conference last month promised a bright future for the implementation of EHR systems, buoyed by American Recovery and Reinvestment Act (ARRA) funds, but that’s only part of the story.
Funding is available, but it comes at a price. The funding is slated for hospitals (referred to by the government as “meaningful EHR users”) and physicians must commit to working with a hospital exclusively in order to obtain funds for EHR. Further, the ARRA funding will sunset in 2013, after which the physicians will need to fund support of systems themselves. Costs will include continued software licensing costs and upgrades to hardware; added storage; training staff to use the systems; compliance with privacy issues; off-site storage of data; and so on.
That leaves a lot in the lurch. Patients with chronic conditions may have been in treatment for years, resulting in substantial amounts of information requiring conversion to electronic form from paper. A failure to convert prior records results in an incomplete picture of a patient’s medical history and the potential for improper diagnosis of conditions and care.
Any of this information in electronic form may be in proprietary formats, or unavailable because it belongs to other hospitals or unaligned providers. And going forward, who pays for conversion of records for these patients once the physicians are no longer associated with these hospitals? Patients are living longer, and their records must follow them as they relocate, change medical providers, move between insurance companies, and so forth.
Medical record formats change over time, compounding the problem. We can’t easily find record players for LPs, media drives for Bernoulli cartridges, or 8-inch and 5-1/4-inch floppies; and opening an MS Word 93 file is nearly impossible without loss of format, fonts, or other features.
Most concerning of all, there are no published standards at this time for the capture and management of EHR information, and while there are plans in the works for the Certification Commission for Healthcare Information Technology (CCHIT), HIMSS, and other organizations to establish them, critics are concerned about the process itself.
There is also discussion about whether EHR information will be subject to industry best-practices and not legitimate standards. Is there a difference? You bet there is! A best-practice is simply a uniform method of doing something that meets the needs of a group of individuals, an organization, or an industry. A standard, on the other hand, is developed by a group under a rigorous set of requirements; it meets a consensus and is open to public comment and review.
These issues are among the greatest concerns expressed by many parties, including highly placed practicing physicians who are informing government officials.
By the way, the federal government has reason to be particularly mindful of these concerns, given that medical records of employees potentially exposed to hazardous conditions must be retained for 75 years beyond separation from employment. For those serving in the military, records retention is permanent.
In summary, the current approach to EHR puts the funding cart before the standards horse. This situation must be reevaluated to avoid spending countless dollars in vain, only to necessitate the continual re-collection and conversion of information due to a lack of a standard interchange format that satisfies all of the participants involved.
And yes, there still are concerns about privacy, but we can talk more about that later…
— Larry Medina has spent 37 years in the Records and Information Management (RIM) profession.