There may have been some legitimate technical reasons for this lack of consensus. However, because cost-effective care is the catchphrase that constantly rings in our ears, the inability of the government to mandate these changes, especially as it was doling out $35 billion in incentive grants, is surprising. Truly shared records reduces the likelihood of a medication error, a huge source of medical injury, and ready access to lab test results and imaging studies eliminates the high cost of redundant and unnecessary tests.
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Explore This IssueJuly 2015
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An Epochal Event
Unlikely as it may seem, this stalemate was the favored choice of the EHR providers. They prefer the lack of universal transferability of records or inoperability, because this allows each of them to create their own electronic version of “gated communities,” where providers can interact only with others who work within the same proprietary record system. For the largest providers, this strengthens their sales pitch. It may be a key reason why one provider, Epic, based outside of Madison, Wis., has already garnered over 40% of the entire EHR market. Once Epic was awarded the contract to create the EHR for the Kaiser Permanente Health Plan of California, a torrent of customers followed.
Recognizing the benefit of being able to reside in the similar gated community as the Kaiser medical records, one by one, some of the largest hospital systems in California followed suit. These included four of the five University of California hospitals, Cedars-Sinai Hospital in Los Angeles and Stanford University Medical Center in Palo Alto. Other major systems followed, including Johns Hopkins in Baltimore, the Mayo Clinic in Rochester, Minn., Northwestern University in Evanston, Ill., and recently, my employer, Partners Healthcare in Boston. Like our canine friends who learn to play within the confines of electronic fences, large hospital systems are learning this trick, too.
As someone who has used an electronic record since 1989, I find the training required for these new systems can still be daunting. I recently experienced all of this first hand, as my hospital converted its easy-to-use, internally developed electronic record system, LMR, to the Epic system. Fourteen thousand employees were required to travel to offsite locations in the Boston area at odd hours to complete the requisite 20 hours of training.
There were several jarring discoveries. Despite the various claims, the key purpose for these records is to capture each and every event or transaction that takes place in a visit. These software programs are essentially giant, powerful vacuum cleaners that suction up all possible medical charges. No crumbs are left behind, hence those 11 clicks to order and bill for that pneumonia vaccine.