Electronic health records (EHR) have been hailed as a huge technological breakthrough in Health Information Management sciences. And while EHR brings many benefits, there is still a long way to go before electronic records are available to us at the “push of a button”. In fact, the idea that EHR has solved everything for us, and that medical records are now easily available from the Provider, is a common misconception. Healthcare providers have a lot of work to do before we will begin to see seamless and efficient methods for EHR storage and delivery.
Last week I met with Erin Ussery, a leader in the Health Information Management industry, to try to get to the bottom of what is going on with electronic health records. In particular, if electronic records are supposed to be such a huge breakthrough in efficiency and cost-savings, then why is it still so difficult to pry records out of hospitals and why are records still so expensive? What I learned was quite revealing, and a couple of brief examples illustrate the challenges that healthcare facilities continue to face while they try to “go electronic.”
In the early-to-mid 2000’s the electronic health record industry was “hot”, resulting in a blitz to develop and sell EHR systems as quickly as possible. The healthcare industry became saturated with EHR possibilities which resulted in different EHR systems being installed within one single hospital. This inevitably led to incompatibility issues. Take the Swedish Edmonds Campus, for example. Swedish Medical Center is an advanced healthcare facility but their electronic medical record system will make your head spin. According to Erin, “the records custodian at Swedish Edmonds has more than 5 different EHR systems to search through in order to find records pursuant to a request. In addition, the custodian must search the hard copy storage of records maintained off-site by Iron Mountain, as well as entertain the possibility of older records stored on an ancient microfilm system. Billing records are also stored in two different locations depending upon their history: billing records created more than 4 years ago will be maintained off-site in paper storage.” Needless to say, tracking down patient records at this facility is not a quick and easy task.
There is also a recent pattern of conglomeration taking place in the healthcare industry: large hospital systems acquire smaller clinics and bring them under their umbrella. Take for example, a large healthcare system in Yakima with numerous affiliated clinics: pain clinic, cancer center, rehab center, 2 radiology departments, etc.. Nearly each clinic has a different EHR system and several still have records stored on microfilm. Moreover, in order for the hospital to produce billing statements, the custodian must navigate through 2 separate systems: the first system reveals the account number associated with the particular date of service (DOS) and the second system is where you must enter the account number to find the bill associated with the DOS. Sound cumbersome enough? Well, it gets better: this same process must be performed for each DOS. So if the custodian must produce billing statements for 15 dates of service, this same process must be repeated 15 times since there is a different tracking number associated with each DOS visit. The billing statements must then be converted to PDF (15 PDFs) and the multiple PDFs must be merged and excess/blank pages that result from the conversion must be deleted.
Then there is the common concern of excess pages and/or nearly blank pages found in abundance in many sets of electronic medical records. This occurrence may turn what would normally be a 50 page chart into a 200 page chart, which not only increases the work involved to produce the chart, but also increases the cost. Why is this so? Erin states, “One of the most popular and widely used EHR systems is programmed such that each entry made creates a separate document within the electronic record. So there may be 100 pages of records with each page containing nothing more than one or two lines of content at the top of the page. When the record custodian goes to produce this record to the requesting party, each page must be selected, QA’d (“Quality Assured”), and then downloaded separately. It is not uncommon for a 200 page chart to take one whole day for a person to download and QA.”
Speaking of QA (which is really the most important part of this whole process) we haven’t even mentioned the HIPAA disclosure requirements. There are 14 requirements for an authorization form to be HIPAA compliant. Furthermore, the records custodian at the healthcare facility must QA every single page of the electronic record prior to release to ensure cogency between the authorization and the information being released.
What we have found is that the process for releasing electronic records is far more involved than just a “click of a button”. In fact, who would actually want their healthcare information sent around if the only thing the custodian had to do was “click a button.” These HIPAA protections and strict QA and review of records are important safeguards for patient privacy.
Despite these bumps in the road and the current labyrinthine nature of EHR systems, EHR is the wave of the future and holds great promise as the industry moves forward and irons out the kinks in the current systems. According to Erin, electronic records currently take longer to find, prepare, review/QA, and release than paper records. However, we are already seeing many benefits of the electronic health record revolution: “E-records are more secure than paper records, and are redundantly backed up on proxy servers at secondary locations in the event of disaster. E-records can also be securely transferred online much more quickly than snail mail. And new compatibility systems are being developed that allow for the ease of sharing and access among doctors at various clinics/hospitals.” And of course, e-records are phasing out the need for paper and are thereby saving trees. Still, for many people electronic records are difficult to read, navigate, search through, annotate, and so on. Fortunately, MEDRECS is actively creating solutions for these issues such as OCR/keyword searchable PDFs, organized and hyperlinked index within the records, chronologically sorted records and medical record summaries. While the advent of EHR has yet to speed up the release of information process on the provider side, there is huge upside potential and room for innovation in the EHR world while we work to make EHR more accessible and actionable for all parties involved.