In health IT, standards matter

Sarah Kliff has a nice piece up on her own interaction with the electronic medical record at her doctor’s office (emphasis mine):

From the moment I walked in the door, the clinic felt like a model of what these laws are meant to encourage. In reception, I entered my information into a laptop. In the exam room, my medical history, blood pressure, temperature, and details of my earache went straight into a computer, too. I left with a prescription for ear pain medication, as well as a user name and password, so I could access my record at home and, if need be, make additional appointments.

But the clinic also seemed stuck in a lot of what’s frustrating about health care. With the medical assistant, I went through the listing of my surgeries, allergic reactions, family history. The process of rattling off my medical history – which I’ve done dozens of times before, for dozens of other doctors – took longer than the actual appointment. I didn’t even do very well at it; I couldn’t remember the whooping cough medication I was allergic too, so I guessed. But since the computers here aren’t connected to the computers for other doctors I’ve seen, there was no better way about it.

And there’s the rub.

Start with the fact that something like 4 out of 5 physicians in the US are practicing without an EMR right now. Add in the fact that doctors don’t like to change their habits much. Throw in the truth that even though financial incentives are in place, they are totally inadequate to cover the total cost of getting up to speed on meaningful use. It’s difficult to get optimistic about us truly getting going in five years.

But none of that compares to my frustration about the lack of mandated standards in the United States. The problem isn’t just that practices dont’ have electronic records. It’s that even when they do, the records can’t talk to each other.

Let’s say Sarah’s clinic gets totally going with full bore EMR. But when she goes to the ED, they have an EMR from a different company, and no way for the two systems to communicate easily. They discharge her home, but no data is transferred to her primary care doc. Later, when she follows up, her doctor sends her to a laboratory for tests. They, too, have a different system, and it stores data in different fields than her doctors’. Turns out she needs a simple procedure at an ambulatory surgery center, with a fourth way of doing things.

Then her primary care clinic’s EMR vendor goes out of business. They need to buy a new one. But there’s no good way to export all of the data and import it into the new system, so they have to pay someone to manually enter all the data from one to the other.

This isn’t all by chance. It’s actually in companies’ best interests that their systems don’t talk to others easily. That way, when you need to expand, you need to keep adding on pieces from them and not others. But if that’s the case, where are the awesome cost-savings? Where are the efficiencies? Where are the reductions in medical errors?

People can pay lip service to HL7, and Snomed, and LOINC, but those still allow far more ambiguity than you might think. Until we can agree on a standard data format, and require by law that every system can export data and import them at the touch of a button, the reality of Health IT will be far short of its promise. It’s technical, and it’s not sexy, but this is the whole enchilada, in my opinion. I wish the government would get more interested and vocal about it.

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