In response to my note of last Friday (see: Do Hospitals Really Want Interoperable E-Health Records?), Ole Eichhorn of Aperio and The Daily Scan submitted this comment:
Continuing in this same vein, there is a very insightful interview with Dr. Peter Bach posted on the American Public Media web site in which he comments about interconnectivity and electronic medical systems (see: Network is key to digital health records). Dr. Bach is an Associate Attending Physician at Memorial Sloan-Kettering Cancer Center with a special interest in healthcare policy. Below is an excerpt from the transcript with boldface emphasis mine:
You might think interconnectivity isn't that important, but imagine this: In aggregate, the patients of one primary-care doctor in the U.S. see 228 other doctors in 117 other medical practices each year. There's no way that a single doctor can keep track of all these other doctors' actions with faxes, photocopies and phone calls. So, errors are made, expensive tests get re-ordered, and costs just go up and up. Getting doctors interconnected could fix the problem, but there are some roadblocks ahead. No one agrees on the proper data format. Four years of lollygagging public-private "standards committees" haven't fixed that. The layers of privacy and security to protect records have not been totally defined. Most important, doctors and hospitals don't want it to happen. After all, they've spent a lot of money getting you as a patient, buying ads in the newspaper and creating their brand. You are a revenue-generating asset, made stickier because your records are in their possession. They don't want you to go to another doctor who might be better or cheaper. Hanging on to your records means hanging on to you.
Dr. Bach is right, of course. The next logical step after the deployment of EMRs in hospitals, physician offices, and large multispecialty clinics is to link them together in a network to exchange clinical data. As he correctly points out, such a step will reduce errors and avoid unnecessary duplications of tests and procedures. By and large, the patients themselves are now frequently obligated to relay clinical information from one physician to another but they are often not up to the task for obvious reasons. The creation of such a broad clinical network, of course, will not happen for a very long time. None of the various participants in the provider system, both large and small, really want it to succeed, most don't have sufficient capital to build it, most don't have sufficient IT personnel to install and maintain it, and the current healthcare IT standards are not robust enough to support broad clinical data exchange.
Don't expect much help from the federal government which has no deep and intrinsic understanding of the problem or the solution. It can only turn to experts, many of whom have strong connections to the HIT industry and to the very hospitals which have painted themselves into this corner. As noted above, hospital execs do not have a strong incentive to create networks to share clinical data. When pressured to share such data, they merely respond that they have neither the money nor expertise to deploy such systems -- and they will be right.
By way of contrast, such hospital execs, along with healthcare payors, do have a strong incentive to exchange financial data via networks. They somehow long ago identified both the capital and talent to build them. Keep in mind that the key function of hospitals is to drop patient bills with the creation of clinical data as a bothersome byproduct. JohnSharp reports on Twitter from a HIMSS 2009 payer symposium that 95% of claims are currently managed electronically but only 1-3% of hospitals make full use of an EMR. I rest my case.