As internet became more ubiquitous, the expectation of benefits of electronic medical records grew rapidly. Healthcare workers saw reductions in lost records triggering duplicative procedures (an annual $25 billion waste), hand-carrying CDs of imaging studies, fewer unintelligible hand-scrawled notes, and a superior means of consulting on cases among professionals who are rarely available to talk at the same time.
In the mid-2000s, while Congress was absorbed in plotting health care reforms, they understood that electronic health records would lead to better health treatments and less cost. In 2009, just 17% of doctors stored patient records digitally. To obtain the full value from EHRs, it would be necessary for EHRs to be available across the nation.
The one-time nationwide cost would be about $100 billion, but EHRs would save $80 billion per year, an impressive yield. In the Health Information Technology for Economic and Clinical Health (HITECH) Act, Congress allotted $30 billion for hospitals and medical providers to digitize their records and to install EHR systems. In some respects, that subsidy was successful. Hospital use of digital records skyrocketed from 9.4% to 75.5% between 2008 and 2014. Where available, nurses and physicians held a positive attitude toward their EHRs.
While EHRs improved treatments, conserved costs and improved communications within the hospital, many hospitals became isolated from each other and from the physicians who practiced there. A competitive market for EHRs developed, but the competing EHR systems tended to be incompatible with each other and, until recently, the EHR makers dug in their heels dreaming that their proprietary format would thwart competitors from taking their market share. As a result, the preposterous practice of faxing persists for patient records between physicians, testing labs and hospitals. Faxing is used even by health care workers at an EHR system at either end of the transmission – because rarely are the EHRs compatible. Faxed documents appear more useful than they are. They are images, not truly susceptible either to being edited or machine interpreted as emails or text messages.
The Office of the National Coordinator for Health Information Technology (ONC) reported to Congress on this problem in 2015. Careful to avoid naming culprits, the ONC said “some persons and entities are interfering with the exchange or use of electronic health information in ways that frustrate the goals of the HITECH Act and undermine broader health care reforms.”
One provider, EPIC, dominates with about half of the market. Many of the smaller EHR providers have joined together in CommonWell to foster technological approaches that will achieve interoperability. CommonWell embraces a Health Level Seven/Argonaut Project called Fast Healthcare Interoperability Resources (FHIR) specifications. FHIR will enable outbound query and retrieve capabilities to access data across the network, a huge step in the right direction for patients, health care providers, and the EHR industry. Of course, not all CommonWell members have yet integrated FHIR into their products.
It will take the industry several years for most to make their products FHIR-compliant. The 75% of hospitals already reliant on a specific generally incompatible EHR, will need to select and retrofit to a compatible EHR from the marketplace. Achieving EHR interoperability will probably take many more years.