By MERLE BUSHKIN
I recently asked my Primary Care Physician’s Medical Records Department for copies of my records covering the last eight months during which I had four office visits, five blood draws, and nine brief email exchanges. I should add that my PCP uses one of the two most popular EMR systems.
To my astonishment, I received 274 pages of digital records (PDFs). I’ve heard of “record bloat” but this was an explosion!
When I analyzed their contents, I found that 59 pages were legitimate documents containing “original” information and data. 22 Pages were Office Notes — or what are often called Progress Notes —applicable to my four visits; 14 were reports of my five blood draws; 23 included my nine email exchanges. In short, they were “normal” — what you’d expect from the number of contacts I had with my doctor and his lab.
But the remaining 212 pages shocked me. They were totally unexpected and, in my opinion, completely unnecessary! They were a slicing, dicing and recasting of the contents of the basic 59 pages! They included 82 pages of “Ambulatory Visit Instructions” (which I was never given), and 62 pages listing my immunizations, meds, problems, procedures, orders, and past medical, social and family histories — all of which are covered in my providers’ Office Notes!
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!
Question: What do ransomware, malware, the lack of medical record interoperability, power outages, floods, hurricanes and tornadoes have in common?
Answer: They make it impossible for doctors to access their patients’ electronic medical records — which can have disastrous and costly consequences for individual patients, families and our society as a whole.
The irony is that this is an unintended consequence of one of the most successful, albeit forced, programs to quickly move an entire industry from paper records into the modern age of electronic records. The theory was that when all providers keep electronic records and they are linked together via electronic networks, patient records will be instantly available anytime, anywhere patients require care. Regrettably, it’s not that simple.
I’m tired of profit-bashing and business-bashing in healthcare. And every American should be, too!
Well-run, profitable businesses, along with our sense of decency, democratic institutions, education and free enterprise systems, and adherence to the rule of law, have made the United States the most extraordinary nation in recorded history. Together they have unleashed the talents, creativity and productivity of our people, generated enormous sums of capital, and created unheard of social, economic, scientific and political advances.
Is there anything nobler than providing the environment and opportunity for people to fulfill their potential and achieve their dreams, and for providing the goods and services that enable people to raise their standard of living? Not even the practice of medicine can do so much good for so many people. But that’s precisely what businesses do. (That also may explain why far more Americans today are interested in job creation than restructuring healthcare.)
In our system, an individual has an idea, attracts capital, and hires people to build a product or provide a service. When they meet a need, they prosper – and attract more capital and hire more people. Everybody wins. If they fail, they alone suffer the consequences. That’s what capitalism is all about and that’s what has made America great.