Imagine the horror of shattering your pelvis in Nevada, only to, upon your relocation to California, discover that there is no record of the injury, the treatment, or the frightening car accident. Where did the record go? Likely still sitting in Nevada, and likely never to be seen again. Furthermore, imagine being highly medicated, recovering from said severe pelvic injury and thus unable to badger a hospital into transferring necessary records. Imagine trying to manage the most basic of needs and being too exhausted to handle the draining back-and-forth communication thread required to access your own records. And yet, this is nothing compared to what those with complex serious illnesses experience. Catastrophic events or serious illnesses aside, the average person has at least seven unique records in different places, and according to the CDC, one in four Americans have multiple chronic conditions requiring longitudinal medical attention whose records are stored in 19 or more locations. Even within the most trusted EMR’s, data is siloed by virtual walls and gross inefficiencies. Such record disbursement is an ongoing crisis threatening the credibility of the United States healthcare system and the health of people who use it. Let us not forget that hospitals are also a business. In America, 25 percent of a hospital cost goes to administrative overhead-greater than any nation worldwide and a byproduct of shuffling around billions of faxes.
The first Electronic Medical Record was invented in 1972 by the Regenstrief Institute in Indiana, but due to its exceptionally high cost was relegated only to use by government hospitals and ambitious institutions. In the decades since an impressive number of them have popped up. The birth of the internet in 1990 spawned a whole new class of innovation and continues to do so. In 1998 Paul Krugman famously and incorrectly predicted that “the internet would slow drastically” and that “by 2005 or so, it will become clear the internet’s impact on the economy has been no greater than the fax machine’s.” His failed prediction is underscored in 2011’s Affordable Care Act mandate that all records go digital and by the ever-presence and expansion of the internet in all corners of our lives. The goal of EMRs has always been for data to flow freely, regardless of the location of service, but the industry hasn’t yet made this possible.
"The goal of EMRs has always been for data to flow freely, regardless of the location of service, but the industry hasn’t yet made this possible"
Now that the groundwork has been laid though, an inconvenient byproduct of widespread tech-literacy is that consumer demand is now outpacing technological innovation. The Journal of Healthcare Finances cites that the lack of share-ability across geographical and digital barriers contributes up to $1 trillion in lost human potential due to medical error. And according to studies conducted by the federal government, 40 percent of patient data isn’t available to providers at the time of care, and if it is, 29 percent of that data is not presented in a useful format.
What we’re facing is an interoperability crisis.
There are four key pillars of interoperability: find, send, receive, and use. Only a quarter of providers can do all four, leaving a whopping 74 percent of opportunity to provide better care on the table.
EMR adoption sits at a strong 93 percent. However, each year we spend $27.5 billion on data movement and transformation. Despite our investments, fax and efax, phone, and physical paper remain the top three methods of data transmission due to the lack of a stable, scalable interoperability technology. Meanwhile, people are dying. Johns Hopkins estimates that a quarter of a million Americans die each year due to medical error including but not limited to medication and drug events and missed or late diagnoses. It’s not enough that data can flow between systems-data must be useful, it must tell a patient story, and it must augment a physician’s existing expertise. Today FHIR is the best agreed upon standard, and indeed it is the first modern language for healthcare data, but it cannot instantly and successfully connect end-to-end workflows. It would take an immense amount of labor under the traditional tools and resources to do so. So while we have the language, the imperative still sits squarely with the opportunities for innovation that only technology can provide.
Luckily, we have the resources and tools to fix this. It’s not too late to rise above the existing mess and provide next-generation technical solutions that work within our existing frameworks to stitch the diverse landscape of record keeping together. The internet has provided us with more than anyone could have imagined and the same will be true when healthcare data flows effectively. This is the logical and unstoppable future before us.