In Vermont and across the nation the vast majority of doctors offices and hospitals have been undergoing a shift from paper to electronic medical records. But the challenge is that many of these software systems don't actually talk to each other.
Dr. David Blumenthal directs The Commonwealth Fund, a foundation that conducts health policy research. From 2009 to 2011, he was in charge of modernizing the nation's medical records systems.
Blumenthal spoke with VPR about how health care providers are tackling the issue, and incentives that could help bring about more rapid change.
On improving communication between systems
“It has not been [an] insurmountable [challenge.] There are many places where exchange of records happens, pretty much effortlessly. There are some states where virtually all hospitals are talking to each other, but it is not been easy everywhere and there are some basic obstacles that need to be overcome.
"The first, is that there need to be some refinement of the standards that govern the communication of records with one another and also the way in which information is stored.
"Even more important is, we need to create an economic incentive associated with the exchange of information. If it were critical to the business of hospitals and physicians to be able to share information, we would have done this much better and much sooner. But the fact of the matter is that it costs money. It requires changes in behavior.
“It is generally harder for small hospitals that have less in the way of resources to make the transition to electronic health records. Interestingly though, what we find is that the less competitive the health care markets are — that is, the fewer institutions there are locally — the more likely they are to engage in exchange, which gets back to this issue of the economic incentives for change."
On economic incentives
"The kinds of changes that are already underway — though not everywhere — through the Affordable Care Act ... have made it beneficial for institutions to lower the cost of care and improve quality.
"If you take responsibility for a population, as increasingly is the case under the Affordable Care Act, then it really becomes essential for you to know everything that has happened to the patients who form that population, because you're on the hook for expenses, including expenses that result from duplicative testing and from mistakes that occur when you don't know what has happened to the patient when treated somewhere else.
"Among the most interested organizations in exchanging information are the Veterans Administration, for example, or the Kaiser Permanente health plan which is a prepaid health plan. These organizations, that have pioneered exchange — because they are taking responsibility for all the costs of care — they need to know as a business matter. They need to know what's happening to their patients."
On Vermont's digital records exchange
Vermont now has a centralized repository where all digital medical records can live, and any doctor can access them.
Blumenthal says that while having records stored in one location is not required for an exchange to work, it does raise extra security issues.
"You don't need to have a central repository that is a single place where all the records reside in order to exchange them. The central repository is one straightforward way to accomplish this.
"It does raise a certain amount of additional security issues. It requires that the population trust whoever is in charge of that information, to store it and to protect it. That is not something that's as easy to do in many states, especially states that don't trust government or government-sanctioned organizations."
On the future of digital medical record exchanges
“I think there's a inevitability to march of technology. I think it will eventually overcome … the technological obstacles related to standards and the business obstacles related to competing health organizations.
"Those reduced costs are beneficial to society as a whole, to insurers and employers. They're not beneficial to health care providers. In our current system, on a fee for service basis, you benefit from doing more and if you eliminate unnecessary testing you're actually reducing the revenues to health care organizations.
"We need to reverse that. We need to make it ... a business imperative for providers, doctors, hospitals, independently practicing nurses, to know about duplicative and unnecessary testing and to prevent it through that knowledge."
This piece is part of VPR’s series, Digital Diagnosis, looking at the way information technology is changing how health care is delivered.
