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June 1, 2015 Experts Corner

Electronic med. records no cure-all to health industry’s woes

Dr. Michael Schwartz

There is a terrible disconnect in the healthcare system. With the introduction and mandated utilization of electronic health record (EHR) systems (the computer brought into the exam room by your doctor), the government and healthcare industry hoped to create a method to better monitor and streamline healthcare records.

Unfortunately, they left out a very important component: the sharing of information between the various EHR systems. Currently, there is virtually no mechanism for the different companies to share this information, thereby preventing physicians and healthcare facilities the ability to learn what others are doing or have done with respect to patients' health care. This is not only potentially dangerous but unnecessarily costs the healthcare industry hundreds of millions of dollars each year.

Here are two examples that illustrate failures of communication and a perilous flaw with the EHR system.

Recently, I saw a new patient in my office who complained of having three months of chest pain and shortness of breath. He stated that he had undergone a heart stress test approximately four years prior, which he reported was normal. Unfortunately, he did not recall the name of the cardiologist who performed the test or even where it was performed. He had no information with him pertaining to exams, and his prior primary care physician had retired.

As customary, I performed an electrocardiogram (a heart test) in the office, which revealed a possible heart attack. I immediately sent him to the hospital for evaluation. Later in the day, I received a call from the emergency room physician informing me that he had been discharged.

After a cardiologist was called to the emergency room to perform a consultation, he went through the hospital records and was able to ascertain that the patient had a similar EKG in the past and a complete negative heart evaluation only 10 months earlier (not the four years the patient had recalled). His evaluation in the emergency room was normal, and he was sent home.

The charge for this unnecessary visit may have cost the healthcare system several thousands of dollars. Furthermore, it was an obvious inconvenience for the patient, who could have simply been sent to his cardiologist for a follow-up evaluation the next day.

Another example occurred recently when I saw a patient who was placed on a medication (by another physician) for a toenail fungus. Disturbingly, I had never received a report from the doctor informing me that the patient had been started on a new medication. During the visit, I quickly noted in the patient's chart that he was already taking another medication that was contraindicated with the medication prescribed.

The podiatrist who prescribed the medicine was unaware that the patient was taking a medication that would interact. Furthermore, the patient filled the prescription at a different pharmacy, which didn't have a record of his usual medications in its computer system. Fortunately, I was able to identify this potential interaction and stopped the medication before an adverse reaction occurred.

Although these EHR systems were intended to address these informational issues, they are actually causing more problems than they have resolved as physicians rely on them daily to recognize discrepancies in care. Unless these EHR systems talk to each other, they create the potential for dangerous outcomes and often add to healthcare costs.

So what is the solution? It should be as simple as requiring electronic health record companies to create a sharing mechanism. Regrettably, this would cost their industry millions of dollars in order to transform the existing systems into an integrated one.

Consequently, if these EHR systems were indeed connected in some way, physicians would have the ability to easily change from one company to another. Currently, it is very time consuming and financially prohibitive for physicians to move from one EHR to another as all the medical and demographic information would have to be manually input. Therefore, any attempt to integrate EHR information is probably offset by the possibility of EHR companies being concerned about losing revenue.

So what can be done to resolve this issue while at the same time maintaining good health and alleviating the financial burden placed on the current system?

Two solutions come to mind.

First, patients should be diligent about keeping all their medical information in their wallet or on their smart device. Several apps exist today that make it simple for patients to list all their medications, test results, and the physicians they see. Additionally, the information can be password protected to ensure confidentiality.

A more novel approach would be for a company to create a medical cloud. Simply stated, patients could be issued a complex password code (using numbers, letters, and characters) that would then be stored in a medical cloud. Regardless of the EHR system, once inputted, the information would be transferred automatically to this cloud, allowing any approved user access to all your medical information utilizing your unique code. This program could save the medical industry millions of dollars and undoubtedly save lives as all information would be readily available.

Dr. Michael Schwartz is board certified in internal medicine with a private practice in Darien.

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