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Why can’t we transfer electronic health records?

Can’t we all just talk to each other? It seems like such a simple question. But when the context is electronic medical records, the answer is anything but simple.

Healthcare technology has managed to run ahead and fall behind. In these Jetson-esque times, after a GI patient swallows a capsule-shaped camera, a doctor can watch video shot inside the intestinal tract.  Yet most EMR systems can’t communicate with each other. And healthcare workers often have to resort to faxes, a 40-year-old technology, as a backup plan.

Although they were designed for an industry where the timely, safe and effective delivery of medical care relies on the ability of different healthcare facilities and providers to share information, most modern EMRs cannot share information with other systems. More often than not, they are islands of information cut off from direct contact with the rest of the world.

It’s not uncommon for a hospital EMR to be incapable of sending or receiving information from doctor’s offices, labs or imaging centers outside the actual building. Sometimes the EMR can’t communicate with other electronic systems in the same facility.

These information silos grew out of an isolationist mentality. When healthcare providers and facilities look upon medical records generated on site as their property, what some may view as a simple “sharing” of information may look to others like a leak that could put themselves at a competitive disadvantage compared with other facilities or providers. They may fear that they’ll lose patients if the patients’ records are readily available elsewhere. Patients would more easily “walk” if their records were so easy to transfer, the thinking goes.

A fear of competition on the part of EMR companies is also holding us back from a world where systems can speak to each other. Businesses may assume that standardization so that systems are compatible will take a bite out of their market share. But you could argue that standardizing can lead to a slice of a bigger market for companies vying for a place in the EMR space. If all EMR systems could communicate with each other, another line of thinking goes, there would be less resistance on the part of providers to get on board.

The biggest blame for the lack of a standardized EMR system should be placed at the feet of the federal government. With its Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH), the government offered financial incentives for early adopters of electronic health records and defined the kinds of information and EMR would need to be able to store. But HITECH failed to define compatibility standards and it did not did not insist on compatibility among systems. That’s left us with the fragmented systems we see today.

It doesn’t seem likely that the industry will voluntarily create standards to adhere to. At a time when government is under pressure to cut healthcare costs, the advent of a system in which healthcare records can be easily accessed could make healthcare delivery more efficient and therefore more economical. It would reduce the incidence of duplicated labs or tests. And providers would be less likely to prescribe drugs that might interact with their patients’ other meds. Before EMRs can really take off and deliver on their promise of making healthcare more efficient through ease of communication, the federal government must require all EMR systems adhere to compatibility standards. Until then, most EMRs will stay isolated, surrounded by a moat.

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