Everything You Need to Know About Electronic Health Records
As our personal information continues to migrate online, our medical records are following. Electronic health records are digital versions of paper records that contain information about health care visits, lab tests, prescription medications, drug allergies, and doctors’ notes. In theory, you and your doctors can access them from anywhere, leading to more-informed decision-making.
For decades, doctors scribbled notes about patients’ health on paper charts, which were then stored next to hundreds of other paper files in the office. At the time, only large hospital systems had digital records because the cost was too great for small offices.
Things changed in 2009. That’s when, in an effort to reduce the financial burden of transferring from paper to electronic, the Health Information Technology for Economic and Clinical Health Act began providing stimulus packages to health care providers and hospitals that adopted a government-certified electronic health record system.
“EHRs formalized the process, and gave [doctors] the ability to use data to better predict diagnoses, assist in health maintenance, and allow for a much better patient experience than having everything written down,” says Sol Lizerbram, MD, cofounder and chairmen of the board of HealthFusion, which developed MediTouch, a cloud-based medical record system that offers tools for medical charts, pharmacy and lab connections, and a patient portal, among other features.
The government’s Office of the National Coordinator for Health Information Technology estimates that 93 percent of eligible hospitals and 76 percent of physicians and other health care professionals now use health information technology as part of that incentive program. That spells success, says Sarah Corley, MD, vice chair of the Electronic Health Record Association and chief medical officer at NextGen Healthcare, a company that sells electronic record software and practice management systems.
“[Electronic health recording] get[s] an A for adoption,” says Erin Siminerio, MPH, consumer e-health policy analyst at the Office of the National Coordinator for Health Information Technology. “What we’re really focused on now is making sure the systems can talk to each other, that they can not only share information, but there is an ability [for the doctor] to query to find information [when medically necessary] about a person, too.”
The Office of the National Coordinator for Health Information Technology has been able to track the use of electronic records through the Blue Button program, which is working with more than 650 organizations—including government agencies, pharmacies, insurers, and companies in the private sector—to show people that their personal health data is available and downloadable with the click of a button.
The data comes from federal partners that take part in the Blue Button program, including Medicare and Medicaid beneficiaries. “We know that we’ve hit a million beneficiaries who have gone online and accessed their health information that way,” says Simone Myrie, a public health analyst and Siminerio’s colleague.
In addition, she says over a million people have accessed their health information online through the Department of Veterans Affairs, and about a quarter million have logged on through the Department of Defense.
Several studies have shown that people become more engaged in their health when they have access to their health information, says Siminerio. One study, published in BMJ earlier this year, found that being able to access their doctors’ notes online led people to take their medications more regularly. “What that says is when people are invited in, and when people have the ability to get engaged in their health, they are very receptive to that,” Siminerio says. And that can help people better stick with their medication schedule and doctors’ orders.
Other studies have shown that when people have access to their online medical records, they say they better understand their health. That’s important because 40 to 80 percent of information health care providers discuss during a visit is forgotten immediately, says Myrie. “Having access to that information, especially the physician’s notes, is very important in terms of compliance,” she says.
In certain instances, electronic record systems can exchange data, such as when a doctor sends a patient to get a test at a laboratory that connects to several different electronic health record systems, including the one that the doctor uses. But as a whole, the biggest problem with electronic health records is what’s known as interoperability, or the ability of different systems to communicate with each other.
As electronic records exist today, there are gaps in information. We have bits of our health history distributed all over the place: prescribed medications at the pharmacy, results of a physical with our primary care doctor, and surgical information at the hospital. The goal? A single system that holds all of that data—and more. For now, electronic records seem to exist in the bubble of individual doctor’s offices and hospitals. A Black Book Market Research survey found that 91 percent of doctor’s offices and 70 percent of non-system hospitals were not routinely sharing patient health data with outside organizations.
The survey also found that 86 percent of health care providers, 69 percent of insurers, and 81 percent of technology vendors viewed electronic records as being unpredictable. (For instance, it’s not guaranteed systems will always link with one another.) Another study, from Chilmark Research, found that many electronic health record systems lacked effective online patient portals, which could encourage patient engagement—if available and functioning properly. In particular, tools that kept people engaged between visits or after being discharged from the hospital were missing.
“Like anything new, there is a learning curve involved,” says Corley. In some cases, electronic health records seem to add to the medical workload, not streamline it. “[Doctors and office staff] need to distribute the workload equally so that there isn’t an additional burden,” says Corley.
For patients, though, a major worry tends to focus on security—and what happens when it’s violated. “While some people worry about security breaches with their health information living online, it’s actually much safer there,” says Corley. “Only authorized users with appropriate usernames and passwords can access the information.” Plus, certain technical safeguards are required for use with electronic health records, providing an extra layer of protection. (Learn more about your rights when it comes to your health information.)
The issue of interoperability is beginning to be addressed, says Lizerbram. The government recently mandated that certain standards in computer language be implemented, which will help electronic record systems get on the same page. This is something that the Office of the National Coordinator for Health Information Technology is working to address through policies and programs.
If these issues can be worked out, the future of electronic records is bright. Lizerbram predicts they’ll evolve into something of a superhighway with a bunch of entrance and exit ramps. “Everybody feeds data up to the super highway, and then anybody can download data from the super highway,” he says. This means all of the various bits of your health information would appear in one place, viewable from anywhere.
Siminerio says patients may one day view health data in the same way they do financial information. In one financial app, for instance, you can see your bank accounts, credit card statements, and 401(k) all in one place. Imagine doing that with your health information: Instead of writing down all of the medications you take, an app could pull your medication information from various places and provide a schedule for when and how to take your medication as well as when it’s time for a refill.
“Through technology,” Siminerio says, “there is a way to bring all of that together in order to provide a complete longitudinal picture of somebody’s health and engagement in the health care system, which is very valuable.”
Health Records, Now
The Blue Button Initiative hopes to address information gaps by making personal health data downloadable with the click of a button and easily shareable with health care providers. The tool—literally a blue button—is displayed on health care websites, such as Medicare and the U.S. Department of Veterans Affairs. “Blue Button is a way for consumers, in the absence of systems all being connected, to be the vehicle for getting information from point A to point B,” says Erin Siminerio, MPH, of the Office of the National Coordinator for Health Information Technology. Head here to find out if your providers participate in the Blue Button Initiative.