By MERLE BUSHKIN
With all due respect to the good intentions of Congress, HHS, CMS, ONC and their dedicated advisors, they are pursuing — and for years have pursued — the wrong approach to achieve medical record interoperability. Endless studies, reports and anecdotal evidence conclude that trying to standardize the way medical records are formatted and kept, and linking provider silos via health information exchanges, doesn’t work! It is far too rigid, complex and constraining, and far too costly. Most importantly, it doesn’t meet care providers’ needs for “total interoperability” — instant access at the point of care to a patient’s COMPLETE medical record from all his or her providers.
Despite having held endless hearings, listening sessions and receiving hundreds of responses to their draft proposals, they continue to ignore reality. Healthcare is dramatically different than banking and travel, the industries they frequently cite as role models. It is perhaps the most massive, complex, diverse and decentralized industry in the country, and requires a very different approach than used in simpler industries. Standardizing record content and formatting simply doesn’t work in healthcare.
Instead of trying to force care providers to accept their pre-conceived technology, they should adopt technology that meets the unique needs of providers. Simply put, they are trying to cut the man to fit the cloth rather than the cloth to fit the man!
Fortunately, there is a simple solution that accommodates the complexities of healthcare and meets the diverse needs of care providers. It focuses on how to MANAGE records rather than how to KEEP them. All we have to do is embrace it!
The Healthcare Industry
The most important facts we must recognize about the healthcare industry are that it is a highly fragmented behemoth, a massive market of patients/consumers served by a vast array of sophisticated providers!
1. It is an incredibly complex industry providing highly disparate services that dramatically impact the lives of its customers — its patients. Provider mistakes can cause enormous pain, suffering and financial cost.
2. It is one of the most labor-intensive industries, consisting of several million highly skilled workers, most of whom write medical records — a million doctors, almost three million nurses and physician assistants — operating in some 6,000 hospitals, tens of thousands of clinics, large and small offices, labs, and pharmacies.
3. It serves more than 320 million people who collectively suffer from an almost infinite number of hard-to-diagnose health issues that often display the same symptoms and many of which aren’t well understood.
4. While some provider organizations dominate their local markets, none dominate nationally.
5. The industry is governed by the laws and regulations of 50 states and the Federal government.
These facts dictate different solutions and practices than are used in smaller industries such as banking and travel. They can’t begin to accommodate the massiveness, diversity and complexities of healthcare. And when improvements can be made to work, introducing and establishing them are often many orders of magnitude more difficult and costly than in less complex industries.
When you understand these facts, the thought of trying to do what HHS, CMS, ONC and Congress are trying to do would be downright laughable if the consequences weren’t so serious and costly! They are trying to force some 4 million care providers to each “standardize” the way they keep medical records so they can electronically share them. An exercise in futility? You bet!
If you’ve ever seen progress notes, operative reports, radiology and other reports, you understand why. They are as different as the people who write them. Yes, they try to format them into standard SOAP categories — Subjective (History of Present Illness), Objective (Physical Exam), Assessment, and Plan, and even sub-categories, but what one provider includes in each category differs greatly from what others include! Some include the purpose of the encounter — the problem or complaint — in a separate section, others embed it in the History of Present Illness section. Some include their diagnosis in Assessment; others in Plan, and so on.
In short, each provider organizes and writes his or her notes in standard but broad categories that work best for them. And isn’t that what we want — providers to organize their patients’ records so they can quickly find the information they need? Aren’t patients better off than if we force their providers to slot their information into very specific categories that may not fit the way they think?
The cost of this misdirected effort is staggering! It includes unnecessary pain for, and the loss of life of, untold thousands of people, and billions of dollars wasted annually!
Fortunately, there is a better way. Isn’t it time to pursue it?
If we focus on how we MANAGE highly individualized, disparate records rather than on how we CREATE and STORE them, providers can search them to instantly find the information they are looking for regardless of where or how it is organized in their notes.
“Search” is the tool that enables Google, Bing, Yahoo and other search engines to find what we are looking for regardless of whether it is in a paper, book, manuscript, newspaper or magazine, or in forms or reports. So why don’t we use “search” to find the information we need in highly disparate medical records regardless of how or where it is stored, formatted or displayed?
The advantages of doing so are enormous!
1. We can do it today. We have the technology. All we have to do is make existing patient records searchable, regardless of their form. A piece of cake!
2. We have to make them immediately accessible to care providers when they need them regardless of disruptions such as power and internet outages or natural disasters. We have that technology, too: Store them on a mobile device owned and carried by the patient. Another piece of cake!
3. It has to be convenient, secure, easy to use and affordable for everyone. Also doable today. A third piece of cake!
Similarly, we need a better way to get providers to embrace our new solution. Instead of threatening to reduce their income if they don’t do what we want, today’s government approach, let’s offer them the most powerful incentive of all: financial incentives such as an increase in their reimbursement rate for uploading their patient’s records, to nudge them to adopt our desired approach. When they do, everyone benefits!
So what’s stopping us? The insistence by those advising government, and the agencies they are advising, that records must be standardized, and that linking provider silos via electronic networks is doable and sustainable. Neither is right!
We’ve spent more than ten years and tens of billions of dollars trying and failing, Isn’t it time to change course and adopt an approach we know works and is available?
It’s time to let doctors be doctors. Let’s fit the technology to the doctors, not the doctors to the technology. We’ll all be better off!
Merle Bushkin is Founder & CEO of Health Record Corporation, creator of MedKaz®, the patient-focused personal health record you carry in your pocket.