Electronic Health Records and Your Pizza Delivery Company

There is a commercial running on CNBC Radio this week from United Health Care that states “Even my pizza delivery company stores my information digitally online.”  What does a pizza company have to do with health insurance?  United is, of course, referring to the antiquated system we have in the US for maintaining paper copies of medical records.  If you have visited a new doctor lately, you are probably aware of the small mountain of paperwork that needs to be filled out before you can be seen.  The forms ask for details about your demographics, family history, current medications, known allergens, surgery history and insurance carrier.   And the forms are required even when your primary care physician refers you to a specialist for consultation.   Equally concerning is the fact that once you actually speak to the specialist you find that they seem to know very little about your situation and medical history.  The situation is not very confidence-inspiring.  You might presume that the redundancy in information gathering is due to the cautious and overly inquisitive nature of physicians, but this is not necessarily the case. In today’s health care system there is very limited sharing of information between different providers.  The limited data sharing that does occur is usually over the phone, fax or illegible handwritten notes, infamously known as chicken-scratch. 

A 1994 study by Dr. Paul Tang found that pertinent patient information is undeliverable in 81% of cases in outpatient clinics.  The statistic is not surprising when you consider that the average person’s medical records are scattered across several different physician offices, hospitals, laboratories and radiology centers.  The scenario is worst for seniors on Medicare visit an average of 6.4 different providers every year.  Dr. Tang’s study is sixteen years since the study, but not much has changed since 1994.  Today’s fragmented and paper-based health record system is the root cause of numerous inefficiencies in the current health care system.  Furthermore, the need for physicians to substitute educated guesses in the place objective data poses serious risks to the patient’s health.  For some patients, missing information could lead to suboptimal care, return visits or adverse drug events.  For others, incomplete medical records could lead to life-threatening misdiagnosis or even death.  Consider the case of a patient being admitted unconsciously to an emergency room.   The attending physician will have no information about recent lab tests, current prescriptions or medical history. 

A study conducted by the Center for Information Technology Leadership (CITL) found that $77.8B in annual savings would be realized by connecting the various organizations in the US health care industry electronically.  In order to achieve the savings, the health care industry would need to deploy a framework for sharing Electronic Health Records (EHR) across a National Health Information Network (NHIN).  An EHR would store a comprehensive set of information about each patient including:

  • Personal demographics
  • Weight and health statistics
  • Current and past medications
  • Immunization status
  • Known allergies
  • Radiology images
  • Laboratory test results
  • Past surgeries
  • Family medical history
  • Discharge notes
  • Appointment notes from by specialists or primacy care physician

Example – Philips Tablet PC for Managing Electronic Health Records

In addition, the EHR might contain

  • Living will, advanced directives
  • Privacy agreements
  • Insurance coverage

Benefits of Electronic Health Records

Electronic records promise a number of high-impact benefits to improve administrative efficiency, enhance the care quality and reduce the spread of disease.  Four examples of the benefits of EHR include:

  • Fewer Redundant Tests – Without access to a patient’s health records, physicians are not able to view the results of recent laboratory tests or to view radiology images.  As a result, many physicians order redundant tests, which unnecessarily inflate health care costs.
  • Safer Prescriptions – Without access to a patient’s health records, physicians are not able to view known allergens, current or historical medications.  Unknowingly, a physician may prescribe drugs which lead to adverse reactions with other medications the patient is taking.
  • Researching Diseases – Pharmaceutical companies invest billions each year in research & development to identify potential cures for chronic diseases.  The time required to discover new drugs could be reduced with access to large pools of de-identified E.H.R. data.
  • Monitoring Pandemics – Public health agencies struggle to get real-time data about medical visits related to contagious diseases.  Access to de-identified E.H.R. data could provide faster and broader access the critical health data that could identify outbreaks or pandemics.

More details on Electronic Health Records and the National Health Information Network in a future post.