How to Improve Electronic Health Records

 Problem

When a patient needs to switch doctors or hospitals, their electronic health records have to go with them. These documents come to the doctor usually in the form of a PDF. This PDF contains all the information on a patient, which is usually around 30 pages for an adult, but can easily balloon into 50-60 pages. Many pages are a waste, as they provide regulatory and billing information, instead of information regarding the patient’s health. This wastes time for doctors, who just have to sift through dozens of pages of useless information, and then input it into their own system. This problem is compounded by both doctors and patients, who would prefer that this information was more readily accessible in the system so that the doctor can spend more time focusing on patient care, instead of on data entry.

Secondly, studies show that since electronic health records became extremely common, the number of malpractice claims skyrocketed. From 2007 to 2010, the number of claims filed was 2. From 2014 to 2016, we see the number jump to an incredible 66. 58% of these claims “were caused by user factors. Examples of these errors include data entry errors, copying and pasting progress notes, and alert fatigue” (Appleton). These errors have consequences, with one patient becoming a quadriplegic due to incorrect information listed in his medical record.

Finally, another problem that plagues EHRs is their security risk. Medical records contain highly sensitive information, and are not currently secure. When referring to medical records, “according to the Office for Civil Rights of the Department of Health and Human Services, there have been more than 200 data breaches in 2017 so far” (Turcotte). Something needs to be done in regards to the protection of this data.

Research Method

There are three different sources I plan on getting my data from. The first is from Doctor Neil Ampel, who has now worked at 3 different institutions in Arizona. In his experience from the V.A., Banner, and Mayo Clinic up in Phoenix, he has used three different systems (CERNER, CPRS, and EPIC). His personal knowledge will allow me to get a more grounded view of the problem and how doctors and patients feel about the digitalization of our health records. My second source will be online research. Harvard Medical School has some fantastic articles, as well as the UA library online database. These articles will prove important as they will hopefully contain quantitative data to complement the qualitative data I will have received from my interview of Dr. Ampel and his fellow workers. Having real numbers to put on my research can help solidify what needs to be done. Further, online forums can help to give an opinion as to how people feel from different areas of not only Arizona, but the country as a whole. While I consider this the least important of my data sources, it can still potentially provide a new context to my research, and help spark the flow of ideas for what needs to be done to change the current system.

I also plan to contact some of the companies I mention further in this paper to get an idea of their process and future plans. These experts can give personalized and highly technical information that is not readily available on the internet.

Solutions

Standards

The proposed solution would be to create a standard for how electronic health records are formatted and shared. Through this standard, new systems would not necessarily need to be invented, but current systems would simply need to reorganize the way their data is formatted, and the way it is output. Systems can still be customized, but would ultimately have to fall within the new standard. This would allow for the quick transferring of EHRs without the need for printing out PDFs and manually entering the data into the new system. Further, we need to move away from the regulatory information that is plaguing the current system, and causing a waste of pages.

HealthHeart

This is a new startup company whose goal is to simplify health records and bring a beautiful new user interface to them, making it easier for doctors to navigate them. Having a dropdown menu that quickly shows history, information from devices (like an Apple Watch or FitBit), along with any other piece of a data a patient wants saved, this new open source software aims to revolutionize how we view health with our medical providers. HealthHeart uses a form of Blockchain to create a decentralized, secure platform.

There are many companies like this currently trying to make EHRs more accessible, I just chose HealthHeart since they have been in the news very recently trying to simplify the EHR. Other companies include PriorAuthNow, which “works with EHR systems and connects directly with insurance carriers. Company executives claim it’s the fastest, most economical way to submit, monitor and complete prior authorizations” (Monegain). The last company I wanted to mention is Augmedix. This company utilizes Google Glass and a custom AI to automatically enter information into EHRs based on the conversation between doctors and patients, freeing doctors from having to manually enter data in a computer and miss important face-to-face time with their patients. With private companies like this working towards interoperability and exciting features, we may see improved patient care.

Blockchain

If all hospitals utilize the blockchain technology to keep a secure ledger of everyone’s EHRs, allowing for immediate access to a continually updated database of these records that is kept extremely secure. I’m not sure this could be immediately implemented into the new standard created through legislative action but could be a potential kicker for later years when the technology becomes truly viable. This also creates the added kicker of a much larger, organized and secure database. This can lead to better analytics and more advanced queries, allowing anything from seeing how a disease is spreading through a state or the country, to better understanding the average age at which certain issues begin to occur. Research companies should be salivating at the possibility.

Legislation

In my previous research proposal, I suggested more legislation might be the way to go in terms of fixing the issue of interoperability. However, after seeing how many independent companies are working on a solution, and the current administration's lack of understanding of health care needs, I’m not sure this is still the way to go. President Trump outlined a plan to revamp the V.A. Electronic Medical Record system, but this won’t go into effect until 2025, after Trump has left the White House. To me it seems like the V.A. will be left behind for at least the next 4 years, while private companies continue to create open source software to solve our issues of interoperability. This is a case where the free market may self-correct the issue.

Implications

In terms of end-user acceptance, it would be mandatory after a certain date, or hospitals could incur massive penalties. The hope is that doctors or patients don’t have to do anything different from the current method of data entry and checking boxes. They would just have to do less of it as the EHR is already online in a readily accessible format. The major problem here is that there would be a cost to entry. Upgrading systems, buying new computers / tablets, digitizing current records into the new format, takes a lot of time and money. This would be a major issue for smaller doctors, who may not have the systems to support HealthHeart or a different software, along with the blockchain to access the EHR.

On the technical side, EHRs already provide problems that would only be compounded by a unified system shared by all. For example, unique patient primary keys would need to be created for all existing people in the United States, which is a massive task to undertake. You could argue to use social security number, but many institutions don’t use that, and it isn’t mandatory to give your healthcare provider this information.

The other issue here from the risk management side is what users get privileged access to all that data, and who gets to decide to give users access? Health records contain private information, and it’s heavily regulated who gets access to it. A larger, more connected network means potentially more control access issues down the pipeline as records get exchanged.

Future Research

Through my research, I hope to prove that this is a viable option, leading to better patient care. While the issue is very complex and will be costly to implement, it will be important for the long term success of our nation’s healthcare, which is already in disarray. I’m hoping my future research can give me a more concrete idea of what data is the most important in the electronic health record, and where exactly to place each piece of information to create the most efficient standard. If the PDFs can be unified, a doctor can know exactly where they have to look for certain information if they can’t use their computer system. It might be that adding tablets to the experience for all doctors creates better data entry since a doctor doesn’t have to be sitting down at a computer to use one.

Conclusion

Electronic Health Records are currently a clunky version of what could be, but they aren’t beyond hope. With new standards to follow, the negatives can be greatly reduced, while the positive aspects can mostly be kept the same. With these ideas implemented over the course of a couple years, we should see headaches go away, leading to increased customer satisfaction, more time for doctors, and an overall better health care system in America.

References

Bitcoinist. “HealthHeart: Bringing Security, Usability, and Scalability to Electronic Health Records (EHRs).” Bitcoinist.com, 31 Oct. 2017, bitcoinist.com/healthheart-bringing-security-usability-and-scalability-to-electronic-health-records-ehrs/.

“HealthHeart – Next Generation EHR.” Next Generation Ehr, HealthHeart, 28 Oct. 2017, www.healthheart.io/.

Appleton, Randy. “New Study Reveals High Incidence of Errors on Electronic Health Records.” The Legal Examiner, norfolk.legalexaminer.com/medical-malpractice/new-study-reveals-high-incidence-of-errors-on-electronic-health-records/.

Yen, Hope. “AP FACT CHECK: Trump Hails 'New' VA as Old Problems Persist.” ABC News, ABC News Network, abcnews.go.com/Health/wireStory/ap-fact-check-trump-falls-short-promises-veterans-51057370.

Monegain, Bernie. “PriorAuthNow Scores $3.6 Million in Funding.” Healthcare IT News, 30 Aug. 2017, www.healthcareitnews.com/news/priorauthnow-scores-36-million-funding.

Lunden, Ingrid. “Augmedix Nabs $17M to ‘Rehumanize’ Doctor/Patient Relations Using Google Glass.” TechCrunch, TechCrunch, 25 Apr. 2016, techcrunch.com/2016/04/25/augmedix-nabs-17m-to-rehumanize-doctorpatient-relations-using-google-glass/.