5 responses to “My View On Creating A Usable Electronic Health Record”

1. 

   Christopher Kent June 5th, 2009 at 13:11

   Please don’t take what I am about to write the wrong way, but I believe that the ATM analogy may be a little simplistic.

   Let’s flesh this out a little. What was the “symptom” that drove you to the ATM in the first place? You had no cash right? So in this case the bank ATM was essentially the care provider for the ailment you suffered, which was not enough 20’s in the leather.

   It’s an easy fix for sure, but in this case, the Bank is NOT performing the roll the insurance company plays in our healthcare system, the ATM is – a very fine distinction, but one worthy of note. After all, when Russell Artzt was in France, I highly doubt that he even went to an ATM that was associated with his bank, just like we oftentimes are forced to see a doctor that may not be a direct care provider for our insurance company. Under no circumstance simple or complex, would I EVER WANT my insurance company playing the roll of a medical care provider in my life either, the same way I avoid going into the bank at all costs for $100.00 cash. Look at the state of the insurance industry today – they are only marginally better than the Banks and Wall Street firms. If we relied on the insurance company for care, we’d all die a lot younger at the hands of insurance stock holders.

   In your example, the supplier of cash/currency INTO the bank account is ultimately playing the role of an active health insurance policy. As is the case in real life with employment statistics nowadays, too many people are without jobs and thus, cannot keep their bank accounts filled… too many people are also without proper insurance coverage. To some degree the two issues may be linked, but another reason people don’t have insurance coverage is because the cost of coverage is too great for many families to bear without help in the form of employer or state funding.

   I know that I have not provided better clarity with regard to what SHOULD be done with the medical industry, which is a personal pet peeve of mine, however, the situation is self perpetuating. As the number of underinsured grows, it will continue cause the macro economic picture to worsen with regard to insurance costs. Every time a care provider can’t collect for a procedure, the rest of our costs (billed through insurance companies of course) goes up to make up for unpaid service provided. Insurance companies just provide the clearinghouse/vehicle for providers and payers, doctors and patients in this case, with a little bit of regulation thrown in for good measure. Creating a more efficient process (which is what EMR is all about) can only help the situation, not hurt it, although just like you, I question whether or not it will solve the problem.

2. 

   Rich June 5th, 2009 at 16:12

   Chris, thanks for the feedback. No offense is taken. The idea of this posting is to do just that, get people into the discussion. I certainly don’t have all the right answers.

   To clarify my point a bit better, I was not suggesting that the insurance company/bank be assuming the role of a care provider. I meant that they would be the custodian of the electronic health record since everything has to go thru them anyway. My doctor has to get a test OK’d prior to writing a prescription for it. The contact my insurance company and get an authorization for it and I go get my test. The test center will send electronically the films and results to the insurance company’s ‘bank’ where my EHR resides and my primary care physician will access the results from her office. She can then create a course of treatment based on those results, which is entered into her practice management application, which will also upload to my ‘bank’.

   I know all of this is a bit on the simplistic side, but we have to start somewhere. Someone coming up with an idea or template and then having other people make suggestions to refine it is what we need to do.

   I don’t want to restrict the right of any practice management software company. What I do want is for them to be able to all include a feature that would allow what a doctor enters to be uploaded (without any additional costs to the doctor)to the bank. Call this a part of doing business.

   Lastly, we need one standard, not multiple, expensive, confusing versions.

   Thanks for the feedback and feel free to pass this on and continue the discussion.

3. 

   RE June 7th, 2009 at 09:43

   Interesting topic, though at the end of the day adoption is going to be top down not bottom up. There are so many players in the market that are trying to be involved with creating the standard that its simply adding to the confusion. Healthcare is big business, big enough that any initiative, no matter how well intent, is almost certainly doomed to be tainted by special interest. Best case scenario here is pushing the needle, I dont expect to see any massive improvement

4. 

   Mark Schlossberg June 12th, 2009 at 17:24

   I like the idea of a centralized repository, but agree that it should not be an insurer. If for no other reason, insurers change. As a small business, I’ve had a few in the last 15 years. So I would suggest having 3rd parties, independent service bureaus be the repositories. (There could be more than one, or it could be the government. Hey, they have my tax records – I’m at least as concerned with the privacy of that information as my personal health data.) Also, the citizen must ultimately own his PHR, so read access to the data (by physicians or insurers) would require some sort of authorization, preferably online. But update access, such as the updating of test results, would not require specific authorization by the individual. (Only authorized parties, e.g. your physician, Quest, LabCorp, would be allowed update access.) And no direct access to the record would be provided when updating; the test results would be submitted in a “lock box” and the update would be done by the repository. The individual would then receive notification any time the record is updated, so that changes could be monitored. Repository costs would be covered by a transaction fee, which could vary according to the transaction. Or maybe the repository could sell advertising when you pull up your record online

5. 

   Rich June 30th, 2009 at 06:13

   Mark, I like your idea of a 3rd party repository. I had forgotten how many times my one full time job had changed insurance companies when shopping for the lowest rate. We changed companies 3 times in 5 years.

   The lock box idea also has a lot of merit. I would take the ‘notification’ one step further and have them send one to the ‘doctor who ordered’ the test. Once a day an electronic update would be sent to the doctor’s office and they could then click on the line and get an update for that test. This way we continue with the paperless office.