Free The EMR

My 97-year-old father passed away last week after a four-day hospital stay  That is a  matter of private sorrow.  However, that experience renewed feelings I have about a particular aspect of modern health care and they are feelings of anger.

I want to make clear upfront that there were no medical errors involved with the care my father  received.  In fact, the care and attention provided by his physicians, nurses and others was exemplary to my critical but knowledgable eyes.  That included an environmental services aide who while cleaning my father’s room noted how sick he had become and took it upon himself to lobby successfully for a private room for my father.

His caregivers, though, were needlessly handicapped by lack of access to important information which might have changed their treatment plan.

My father was still living independently when he died.  He was hospitalized because some lab values alarmed his new cardiologist.  As I was to discover a day later, those values were normal for him and his recently retired primary care doctor had been monitoring them for years.  I discovered that fact by going to the patient portal used by the health care system to which his primary care physician belonged.

The cause of death was something that could have easily occurred at home, something we had become concerned enough about that we had scheduled a meeting of his children prior to the hospitalization to discuss living arrangement options for him.

The hospital was unique in that it had as attending medical staff its  own medical group as well as  medical groups affiliated with two other large health care systems.  The other health care systems did not have their own hospitals nearby and used the local hospital to care for their patients.

The problem was the electronic medical record (EMR) used by my father’s medical group was not accessible to the hospital’s staff.  At least two of the medical groups used the same vendor for their EMR but even then there was no sharing of information.  This lack of what the IT types call “interoperability” continues to be a flaw in the roll-out of EMRs.  It is dangerous and inexcusable.

An example:  early in my father’s hospitalization, a hospital pharmacist came to the room and asked what meds my father used at home.  I had access to his electronic medical record and showed her the list. Why could she not access that list?  The answer has to do with the siloing of medical records to the benefit of everyone but the patient.

Another example:  as I indicate above, I was able to determine by accessing my father’s medical record that his “normal” lab values were abnormal for most people.  The admitting doctor at the hospital had no way to see that valuable piece of information and the result was more testing.

When I was still a health care system CEO I used to go every other year to the headquarters of the EMR vendor we used.  On each visit I raised hell about this issue of information silos.  The last visit I made before I retired I raised enough of a ruckus that the President of the company joined us at lunch to discuss what his company was doing to make the information more easily accessible.  His promises sounded good but to my knowledge nothing has changed.

My father did not die because of this problem but I believe many people have.  There are task forces looking at the issue but they seem to move at a glacier pace.  There is plenty of resistance below the surface to the idea of interoperability.  The information collected from EMRs has value and it seems to me everyone is benefiting except the patient who is the rightful owner of the information.

Access to a patient’s medical information is crucial when that patient shows up at a hospital emergency service needing life-saving care.  Which medical group he uses and which EMR they use should not be a factor in allowing access to information which could be valuable in treatment.

It is not the EMR vendors’ information. It is not the insurance companies’ information.  It is not even the medical group’s or hospital’s information. It belongs to the patient and it is time it has been freed.  When does this revolution begin?

Free the EMR!