Readers Write: The Myth of the Golden Health Record

The Myth of the Golden Health Record
By Peter Bonis, MD

Peter Bonis, MD, is chief medical officer of Wolters Kluwer Health.

In 2009, President-elect Obama signaled his plan for the federal government to support the adoption of electronic medical records (EMRs). His expectation was that broad adoption would “…cut waste, eliminate red tape and reduce the need to repeat expensive medical tests,” adding that, “it just won’t save billions of dollars and thousands of jobs; it will save lives by reducing the deadly but preventable medical errors that pervade our healthcare system.”

The subsequent Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the larger American Recovery and Reinvestment Act, achieved his directive, at least in part; most healthcare systems now use EMR systems. However, the strategic objectives of reducing costs and preventing medical errors have been elusive. Preventable medical errors remain common, growth in healthcare spending has not been reduced materially, and healthcare providers frequently cite EMR systems as being an important contributor to professional burnout. 

In this backdrop rests a common belief that the full promise of EMR systems has yet to be obtained. It will only be achieved once patient data can flow unimpeded from system to system, permitting healthcare providers (and other stakeholders involved in healthcare services) to have a comprehensive view into patient care wherever it is delivered, a concept referred to as interoperability. Over the years since the HITECH act was passed, many barriers posed challenges for achieving such a vision including concerns related to data privacy, deliberate blocking of information flow (especially when it interfered with business models), and approaches to gathering and making sense of intrinsically messy data.

Nevertheless, the journey has continued; key pieces of legislation and advances in technology have led to demonstrable improvements in interoperability.  Most recently the federal government gave the objective a boost by advancing standards and designating qualified health information networks intended to establish a universal floor for interoperability across the country. As a result, the healthcare system is marching toward a comprehensive, golden health record.

But once we have it, will the golden record enhance the quality, safety, and effectiveness of care? The answer is unsurprisingly no unless more is done to use the data effectively. Primary care providers would need almost 27 hours a day to deliver all the guideline-recommended care, according to one estimate. In this context, more information is not better.

Healthcare data must be delivered in ways that are useful for busy healthcare professionals working in varied settings. Information must be high value and organized into consumable payloads and workflows not only for time-pressed individual clinicians but for extended care teams. It should ideally support decision-making and subsequent actions while saving time, reducing cognitive burden, decreasing administrative overhead, measurably improving the quality and safety of care, and reducing costs. The golden health record is a welcome enabler, but will not in itself accomplish these objectives. 

So, what is needed? Foremost is recognition that the matter is critically important. The core of healthcare delivery is an interaction between providers and patients where decisions are made and care implemented. There is much to be gained by making it easier for healthcare professionals to take care of patients.

A greater sense of urgency is needed. Burnout and other challenges are leading to attrition of healthcare professionals. There will be a shortage of primary care physicians and hence a need for advanced practice providers (such as nurse practitioners and physician assistants) to take on greater responsibilities. They will need help. At the same time, healthcare services are becoming more distributed to new sites of care, such as retail pharmacies and to digital health technology companies, creating greater challenges for coordinating care and optimizing flow of useful information. The proliferation of devices that generate healthcare data adds further complexity.

EMR vendors need to expand capabilities, focusing on metrics that are directly relevant to the experience of various user types and ultimately to the quality of care delivered. Financial incentives and payment models must justify the investment for both EMR vendors and providers.

Healthcare professionals want to deliver exceptional care for their patients. Let’s make their needs a priority. The golden health record is a worthy goal, but the usability of the data should get equal attention.