In the previous post in this series, I discussed the obstacles to implementing electronic health data systems. Because of these obstacles, many providers are resistant to replacing their paper-based “databases” with true EHR systems. But assuming the best case scenarios, that all healthcare providers and vendors convert from paper (or quasi-paper) to digital, that still doesn’t fully solve the problem – you’ve still got a lot of electronic data that exists in silos.
For maximum benefit to the patient and, in the long run, to the industry as a whole, this information should be visible across every platform and every organization. Properly authenticated users should be able to access a patient’s health record instantaneously, including even very recent visits to other providers. Non-clinical decision making personnel should be able to aggregate the same information to analyze disease trends and patient outcomes to help identify the factors that lead to illness and the success/failure rate of different treatment paths. This information would need to be available in real-time or very close to, in expectation of large scale, rapidly evolving health situations (avian flu, H1N1, etc.). With this information, front line personnel could quickly make treatment decisions based on previous outcomes and the patient’s own treatment history. Family physicians could immediately access their patients’ healthcare history from hospitals, specialists, and other caregivers, allowing them to make diagnoses and medication/lifestyle changes based on the big picture of the patient’s health rather than simply addressing acute issues as they emerge. Insurers and other entities with a financial stake could better plan for anticipated treatment costs, which could become more consistent with the volume of data used for this analysis. Simply put, the best use of healthcare data would include a large-scale integration plan to insure consistency of treatment and improve patient outcomes.
It’s Not So Easy
Healthcare data integration presents multifaceted challenges, including technical, administrative, and strategic obstacles:
Technical issues include the questions of responsibility and availability: Which entity(ies) will be responsible for insuring the data is always available and is properly protected? Is the data to be centrally located for common access, and if so, who pays for this storage? Some initiatives currently underway include RHIOs (regional healthcare information organizations), which seek to share information on a relatively local level. Properly administered, a national system based on the RHIO model might be a good solution.
Administrative issues include budgeting for data integration, allocating personnel, and integrating the integrated information into the workflow. It can’t be overstated that healthcare organizations, and especially front-line providers, can ill afford distractions, especially those that don’t result in an immediate payoff. From the time required of technical staff to handle the nuts-and-bolts of implementation, to providers who have to learn to access and updated the integrated data, and finally the back-office personnel who validate and audit the information, there is an investment in human capital, which always comes with at least a soft cost.
Strategic issues certainly exists – after all, healthcare data integration violates a cardinal rule of business by simply giving away your most sensitive information. Providers and vendors are under increasing pressure to remain competitive, and sharing patient and treatment information pulls back the curtain a bit, perhaps too much for the comfort of some. Certainly some safeguards would need to be implemented to allow the sharing of information for everyone’s benefit without unnecessarily harming smaller companies.
Hopefully the picture I’ve painted isn’t a bleak one. The good news is that there have been strides over the past few years, and we are closer to true healthcare data integration than we were a decade ago. I think the effort will get a big push with the legislative changes coming down the pike, and while I don’t believe that decisions by Congress will completely address the obstacles, said changes could help establish standards and safeguards to make the process a little less painful for everyone.