Electronic health records (EHR) have revolutionized health care in many ways. Physicians, specialists, billing specialists—even patients, in some cases—have instant access to all the important information they need: lab test results, medications, drug allergies, and so on.
Except when they don’t. If a patient needs to go to a specialist outside his or her provider network, or to an emergency room outside the network, access to the patient’s records can regress from a click of a button to a series of phone calls, faxes, and piles of paper, even when both facilities have EHR systems. That’s because there is often little consistency between such systems, and patients have to rely on a busy human being to pull all the pertinent electronic data and get it to the requesting physician in a format he or she can read: usually, paper.
But even within a provider network, if the system network connection goes down, patient records are inaccessible. Whether an EHR system has an inherent connectivity problem, or whether it’s is installed on an insufficiently robust or poorly configured computer network, this problem still plagues even some large health care networks.
What we have here is a failure to communicate
As an RN, as well as in her career as a medical litigator, Kimberley Winter grapples with non-communicating EHR systems all the time. “I find that systems are so different. This is a large overall problem – not so much the physical way of entering data,” but the way it is formatted, stored, and retrieved on different EHR systems. She often receives requested records via fax, or sometimes on a CD with the electronic record copied onto it.
The printed-out electronic paper is more difficult to read than when it’s on the computer screen it’s formatted for, Winter says. Of course, you cannot search on a text string on a paper printout.
When electronic record systems are incompatible, Winter says, you have to depend on the clinic staff to deliver the correct record to you, and to make sure it’s the complete record, or at least every part of it you need. But harried staff often miss some portions of the needed records. “Usually the first time I get the medical record, it’s not the whole thing. That’s not nefarious… the [parts of the patient record] are not even stored in one place, as physical [paper] files used to be. They’re printing from several different data banks… for example, I might see that there was a consultation, but there’s no report of the consultation; or no list of current medications.”
“It never gets better,” laments a provider in a large healthcare system about the serious connectivity problems that plague their EHR system. “If [EHR]‘s working, it’s great. If it’s not working, you have nothing.” This physician spoke candidly on the condition that her name and employer name not be used.
On her fourth visit with this physician, one patient said, “This is the fourth time I have seen you, and three out of these four times, you haven’t been able to access the records” due to lost connectivity. The patient said she wasn’t angry with the doctor, but with the facility’s computer system.
Healthcare facilities need to work with providers to make it easy for them to deliver excellent care. This includes having ready, instant, and continuous access to complete patient records – access resulting from compatible EHR systems and dependable computer networks. Standards must be set and enforced that allow compatibility across systems. A start has been made in this direction, but it needs to progress quickly yet carefully.
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