As the coronavirus pandemic collides with flu season, barriers to accessing medical information could undermine not only individual patient care but public health. Our ability to successfully prevent, isolate, and control outbreaks of infectious disease will depend on how we leverage data and technology to track its spread and treat individual patients.
One lesson emerging from the Covid-19 pandemic is that we must seize the opportunity to modernize how Americans’ health information is managed. The flow of data between patients’ electronic health records and public health surveillance systems is often a manual process involving paper documents and fax machines. Broad adoption of interoperability — the secure sharing of health information across platforms — has the potential to dramatically improve not only our response to the pandemic but also individual health outcomes.
The urgent need is clear, and the technology is available. But interoperability isn’t happening.
At its core, interoperability is the requirement that all electronic health record systems (EHRs) “talk” to each other, so an emergency room in Wyoming can look up an ailing tourist’s health records in Alabama.
In the pandemic it would work like this: A man walks into an emergency room showing symptoms of Covid-19. His physicians are able to rapidly access his complete medical history. They can triage him faster, no longer wasting time trying to get his information from another medical center or conducting duplicative diagnostic tests. Should he need to be transferred from a rural hospital to one with a larger intensive care unit, his information would be immediately accessible there.
Care teams would be able to track the man’s health before, during, and after his illness. His doctors would have real-time access to records on his underlying conditions to determine his risk for complications. Later, when he recovers, his physician can more easily guide him to additional support he might need after leaving the hospital and ensure continued care coordination.
Sadly, this is far from reality in the U.S. The federal government has rules in place to ensure that EHRs are interoperable, but they aren’t. In fact, the U.S. invested billions in helping providers acquire health information technology. While regulators have been able to build out the infrastructure to store and collect patient data, they have largely failed to encourage interoperability among the various vendors that sell these systems. This has effectively stranded patient data across a sea of disparate systems.
What’s impeding progress toward interoperability in the U.S. is that the majority of EHR systems were designed mainly to improve billing and coding of provider services, not to provide seamless care for patients. Making interoperability a widespread reality requires contending with the fact that vendors profit from building closed systems that are only marginally interoperable. To effectively drive change, American health care leaders will need to communicate the importance of interoperability by leveraging their purchasing power and strengthening the regulatory environment.
Change requires reforming the incentive structure to encourage and require vendors to create and sell systems that can talk to each other. Health care systems, hospitals, and physician practices — guided or encouraged by the market and the federal government — should choose interoperable systems. Public and private payers should implement value-based payment models that reward the purchase and use of interoperable systems. It’s also up to the federal government to implement and enforce standards for EHR vendors that promote interoperability while simultaneously strengthening the protection of personal health information.
If industry and government don’t lead the charge to make America’s health care system interoperable, consumers will bear the challenge of piecing together their own health data across the system — a dangerous prospect that could hinder patient care in the midst of a global pandemic. The free flow of protected data across the health care system ensures that treatment decisions are informed safely and effectively by the most current information available and tailored to the individual. A clinician with complete information at her fingertips can easily see the full picture and manage her patient’s care from the hospital to the pharmacy to long-term follow-up care.
This pandemic will eventually end. But the need for interoperability will remain urgent as we seek long-term solutions to bring down costs, improve care delivery, and increase efficiency in our health care system.
Bruce Broussard is the president and CEO of Humana, a health insurance company based in Louisville, Kentucky, and will be the board chair for America’s Health Insurance Plans in 2021.