Electronic health record (EHR)

What's working — and what's not — in the effort to revolutionize patient record-keeping

Lydia Ramsey

US President George W. Bush looks at an electronic medical-record system during a visit to the Cleveland Clinic in Ohio on January 27, 2005. Reuters

If you've ever moved to a new city or found yourself in the market for a new doctor, then you've likely faced the challenge of transferring your medical records.

For all the work that's been put into health-information technology systems, in 2014 only 34% of doctors surveyed were very satisfied or satisfied with the ones they were using.

Each hospital had its own electronic health-records system, but connecting those, at the moment, is almost impossible. And they're still being described as "clunky," or stuck in the 1990s compared to the flashy consumer technology that we use every day. Those two shortcomings are what healthcare experts hope changes, and soon.

When it comes to innovating electronic health records, "We're at the tip of the iceberg," Dr. Robert Robbins, CEO and president of the Texas Medical Center, told Business Insider.

 

A mandatory push into technology

In 2009, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act, which set up incentives for hospitals to get off pen-and-paper charts and onto electronic systems. Over the next six years, hospitals could buy these information-technology systems, implant them into their hospitals, and receive money in return for doing it.

And this did make a big shift in how many people had an electronic health record (EHR). Before, fewer than half were on a system. By 2015, more than 80% of hospitals in the US had an EHR system in place.

But when legislation got underway, it set out a defined list of what an electronic health record had to be. Companies that had already been building hospital IT systems suddenly had to comply with all the qualifications that the government set as to what makes a piece of software an "EHR."

So, systems that were just set up to handle bills suddenly had to be retrofitted to track patients so that doctors could use them during appointments. And it all had to check out under the new regulation.

"A lot of companies had to do compliance, so innovation got slowed down," said Jessica S. Ancker, a professor of healthcare policy and research at Weill Cornell Medical College.

 

Getting doctors to use EHRs and hospitals to share data

While that innovation had to pump the brakes, that left room for two shortcomings, Ancker said: usability and interoperability.

These aren't technologies that doctors are flocking to. Sure, they contain a wealth of information and aim to make the doctor's job easier when chatting with a patient. But user experience just hasn't been as high a priority, for better or worse, for those building the systems.

"Doctors don't hate technology," Dr. Todd Rothenhaus, chief medical officer at AthenaHealth, a health IT company that offers a cloud-based electronic health system, which puts it in competition with some of the established EHR vendors that build IT systems in-house.

When it comes to new devices or the latest implant, doctors are early to pick it up because it adds value to what they do. IT, maybe less so.

"It's IT that was broken from the beginning," he said.

Rothenhaus said that Athena has been working to redo the front end so that it's as intuitive and easy to use as any other app.

As for interoperability, or the ability for one product to communicate to another and share data — say, to transfer your medical history from one hospital to another — that's a trickier sell. For one, hospitals tend to be fiercely competitive when it comes to their patients. And the health records housed in one hospital might speak an entirely different language from the hospital system across the street.

Ancker compared hospitals to banks in this regard: Banks have an incentive to share their data, since it will help them make money. With hospitals, though, that's not the case.

One way that could change, Ancker said, is if hospitals start getting paid based on the quality of care they provide. If they have to start thinking about the entire lifetime of the patient, then that might mean that they're going to have to bite the bullet and share their data more freely.

"It's driving people to think, 'Guess what? We need to share information,'" she said.

When will we see this innovation hit?

So would there be a day when we could just rip up all the messy, convoluted systems that we've put in place and replace them with an entirely new system that made it way easier to share data and have healthcare professionals use?

"There's a way it would feel very satisfying," Ancker said.

But for political — mainly privacy — and financial reasons, that's not likely going to be how this all shakes out over the next decade.

Cloud-based systems could help cut down on costs because hospitals wouldn't have to lay down the hardware of having an in-house IT system, nor would they have to hire people to manage it. But for many major hospital systems, who may have already put hundreds of millions or more into the process, it would be a hard sell to get them to immediately ditch that investment and pick up another.

But that might be changing. Hospitals will likely hold on to their on-premise health IT systems for a while before thinking about replacements. That's where cloud-based companies could have the edge.

"We like to think we suck the least," Rothenhaus said.