EHRs Can't Do Everything

Posted: 11/14/2013

As seen on HealthcareITNews.com

By: Zack McCartney

Like many other industries, healthcare is becoming more consumer-focused. As Eric Wicklund and Mike Miliard have recently documented for Healthcare IT News, patients and doctors alike have spoken out against EHR solutions for interfering with rather than facilitating doctor-patient interactions. While thorough data collection and analysis, where EHRs offer great value, feeds research at the population level, it seems that the apparent failure of current EHRs to accommodate patients as unique cases has sparked this shift in attitude in the health IT industry.

The issue may not be so much the failure of EHRs, as their falling short of unduly high expectations -- expectations not only from the people who use them, but also the vendors themselves.

"I think it's a myth that EHR vendors are going to be able to provide everything.  Every other industry has proven this wrong, says Joanne Rohde, CEO of Axial Exchange, in an interview with Healthcare IT News.  

Rohde, an exponent of open source philosophy -- she was the COO and director of Health IT strategy at Red Hat prior to Axial -- contrasted open source design with EHR vendors' current design approach, suggesting that large, branded EHR vendors have made the mistake of dictating users' workflow rather than providing them with software that actually complements how they normally work.

"There's no question that modular design, open source practices, iterative design would do a much better job in ending up with things that people want to use...[Epic's] approach is exactly the opposite, and their approach is that we're going to tell you how this works, you have to change your workflows to match our system, and then and only then are you going to get benefits from this system"

This domineering EHR design approach, while perhaps expedient for expanding a company's market share, could backfire with the progressive consumerization of healthcare IT. The question, then, is how to begin to amend this approach in light of this trend.

"I think the [EHR vendors] that will be successful," said Rohde, "are going to be the ones that don't try to hold on to what they have, look at it with a clean slate, and say ‘alright, we need to engage the patient; how do we do that?' and then secondarily ask ‘how does this integrate with the software we already have?'"

More and more, healthcare professionals are talking about patient engagement, though it can be difficult, as with all buzz words, to parse what that means in practical terms. mHealth has grown extremely popular as a patient-centric, healthcare model, and Axial Exchange, billing itself as patient engagement software, has successfully deployed mobile applications for Parrish Medical Center in Florida, the Colorado Medical Group, and several others, following a patient-centric design strategy that offers a health information library, along with numerous health trackers for blood glucose, migraines, pregnancy, and even mood.  In other words, letting patients learn about themselves, to engage in their own care.  

Patient engagement, as the phrase's ambiguous grammar suggests, goes both ways. HIT solutions, like Axial's, allow the patients to learn about and monitor their care so that they can bring more actionable information, and not just numbers or vague descriptions of their issues to physician visits. But, as Rohde said, Axial is "committed to not only the patients knowing themselves, but the hospitals knowing their patients." Axial has also complemented its mHealth work with a provider-side tool for engaging patients, a blind analytics service that allows hospitals to see what health issues their patients are researching.

Still, the lack of interoperability amongst healthcare IT systems, even the multiple ones deployed in a single institution, could hamstring however much progress is made toward engaging patients in their own care.  More-informed patients and providers can't overcome the technological isolation of medical records.

Medical Informatics, Inc., a medical organization based in Rockville, MD, in partnership with Health Tech Hatch, a crowdfunding site, for innovative healthcare projects, is taking a consumer-centric approach to address this industry-wide struggle to achieve interoperability with its My Medical Records project.  The project is currently seeking funding on Indiegogo.com.

Steve Behram, MD, president and co-founder of Medical Informatics, Inc., explained the project's impetus in an interview with Healthcare IT News: "The question that came up for us is how can we bring together paper-based records and branded EMR records? ...How can we make the systems talk to each other?"

With the My Medical Records project, Behram and his team aim to unify patient records with the patients themselves by developing an open-source portal through which patients could access all of their health records at the same time, irrespective of the provider, or record system, from which they originate. For every patient, the portal would generate a Unique Patient Identifier, or UPI.  A patient's UPI would not be stored in a central database, but belong to the patient alone. Patients can then use a Health Security Card on which their UPI is imprinted to tag records from their healthcare encounters. The service transfers tagged records to a secure cloud-space that patients can access at any time, along with anyone else, for example, a physician, they grant permission to do so.

"The patient becomes the intermediary that carries all the information with them as they go from one site to another," said Behram, "so we look at this as a bridging solution, not an EHR solution.  Looking at it this way, the providers are free to choose whichever EMR/EHR vendor they choose...they can choose to stay on paper if they wish to."

To overcome the issue posed by paper records, the project will have a fax-to-cloud functionality. Patients will be able to fax any paper records, then tag the file to send it to their unified record. This functionality will also allow patients to circumvent non-participating record systems, too, as the patient could request a printed version of their record, and then follow the aforementioned procedure.

While the project's initial objective is to grant patients the basic ability to access their records, Behram envisions that subsequent roll-outs will include numerous additional features, such as notifying patients of uploaded lab results or when someone has accessed your records as well as allowing third parties to build onto the basic system, customizing it to suit specific institutional needs: "The way I would look at this is that the very first step is connectivity followed soon by additional features that I think other providers, vendors, and other people can add on to the open source architecture."

Behram pointed out that this project, by facilitating distributed decision-making, could help curb redundant testing and medical errors due to poor communication among providers, two areas with significant potential savings.

My Medical Records will lay its costs on neither the patients nor providers.  Subscription is free for both. In fact, the service will even compensate providers for publishing content to the portal. To offset projects costs, Behram hopes to create volume at the level of the portal via provider content contributions and, like social media platforms, garner third- party interest to monetize the portal.  

The consumer-driven business model of My Medical Records is reflected in Behram and his team opting for a grassroots approach to funding, as they want to harness their users' approval to develop the project, but not have providers or patients shouldering the financial burden of sustaining it.  

"What we're trying to do is get the word out that there may be a better way to bridge these records," said Behram, "and we want patients to buy into this and we want providers to buy in to this."

Behram hopes to raise $100,000 for My Medical Records on Indiegogo.com. The project's campaign began 15 October 2013 and ends 29 November 2013.