Survey: Only 22% of Digital Health Users Use EHRs to Make Medical Decisions

This doesn’t surprise me in the least. After nearly 8 years of cajoling and encouraging patients to use the portal view of our EMR several key things explain why the usage isn’t much higher:
1) Users are not allowed to actually enter data directly into the EMR. They can only make requests to have things checked.
2) Users cannot order refills or new medications. They can only request renewals. Likewise they cannot order lab tests, images or other “products” we have to offer.
3) They cannot document, upload or make changes to documents or structural parts of the chart including their own telephone numbers, addresses, etc. Again they can only request.
4) Even though we’ve opened up direct booking or scheduling the number of slots are very limited.
5) It is true that most physicians, despite being in an “open notes” environment they are still not writing them for the patient. Instead they are most often writing it for the coders, regulators and sometimes for their colleagues who will read these notes. As a result they are very formulaic and don’t convey critical information for the patient.

All of this would change if the patient was the primary user of the EMR and had direct control. Many EMRs would allow this (disabling patient search and limiting the chart to the patient’s own chart). But most clients of EMR’s would become catatonic and scream of HIPAA compliance issues if this capability was turned on.

It is really telling that in most Hospitals individual clinical staff are discouraged from looking at their own record let alone managing it even if they have access to it. When, in facts, NOT allowing someone to access and amend their own charts is a direct HIPAA violation. This is so embedded in our psyche that I have had a very hard time convincing my own physician and nursing patients to manage their own records. Yet those who do find it is immensely liberating and engaging.

So when we allow our patients to actually log into the same EMR we do rather than through a dumbed down portal (even though they can see their entire chart) full usage will not occur. Patients are not dumb. They realize this and are accustomed to logging into Airline systems to make their own travel arrangements, purchasing things on line and conducting their own banking and investments. When medicine joins the “real” world you’ll see a sea change in patient EMR usage.

Understand completely but let’s get off the interoperability band wagon. It’s a red herring. Interoperability is NOT a technical issue. The lack of interoperability is a business, legal and medical issue. Let me explain.

I’m sure you have more than one credit card or bank at more than one bank. Likewise you probably shop at numerous retail outlets. Do any of them share your transactions? Can you log into one bank and see transactions at another? Do your Fitbit steps show up in Apple Health? Of course not. Why? Not for any technical reasons but business competition.

Again, these are not insurmountable technical hurdles but even when you transfer money from one bank to another the only thing that is transferred is the balance forward. None of the transactional history moves from one bank to another.

With regards to medicine it gets really complicated in that even though it’s possible to bring in discrete data (blood pressures, labs, etc.) from another system the attorneys will forbid it as those discrete items will need to be redacted whenever a request for medical information is made as a physician/hospital does NOT have the right to transmit on any information that does not originate from within.

This is why all outside data that’s imported is put “on the left side of the chart” just like it was in our paper records for the last 50 years. Information originating from outside must be separated from internal data for medico-legal reasons no matter how much physicians and patients would like it intermingled for clinical decision making.

In addition to the medico-legal reasons just about every pathologist and lab manager will blow a fuse if a lab value stemming from an outside system or even one that’s done internally with a different methodology shows up in the same row on a results table. This is why point-of-care glucoses do not show up in the same row as those run on an automated multichannel metabolic test machine. Most go so far as to want discrete rows for each test done on different machines.

It’s for these and m any other reasons I think this whole talk of interoperability is a diversion from the real problem of institutions refusing to port their data to Health Information Exchanges and mandating that these Exchanges bidirectional with other exchanges. What everyone should be talking about is making these exchanges mandatory and making them the patient’s portal. That way a patient could go to one place and see all of the information from all of their providers nation-wide without forcing us to change the legal requirements for requests of Health Information.

Would it be easy to open up the Health Information Exchanges to patients? Absolutely. After all every physician who belongs to an organization that is contributing to an exchange uses a very simple web interface to those exchanges to look at patient’s interactions with other providers in the region. Here in Kansas City we have two competing exchanges. One works hand-and-glove with 3 states’ exchanges so if the patient is seen in up to 100 hospitals. Unfortunately the hospital right across the street uses another exchange and the two exchanges are refusing to connect (not for any technical one but for business reasons).

At some point the light-bulb will turn on and we will have a system where a person’s health interactions can be accessed nation-wide but some business practices and legislation will need to change before that becomes a reality.