The ONC released its Nationwide Interoperability Roadmap Jan. 30, setting a 2017 deadline for full nationwide system intercommunication to facilitate better health record tracking. Experts at the ONC meeting pointed out several issues that may arise as EHRs become the standard for U.S. healthcare.
More collaborative health record-keeping
John Mafi, MD, a fellow in Internal Medicine at Beth Israel Deaconess Medical Center in Boston, spoke about a collaborative project called OurNotes, in which the patient and physician work together to formulate a medical record. The patient inputs pre-visit data through a home computer or a computer in a waiting room, and then continues to monitor the information in the health record through two-way access terminals.
Dr. Mafi later noted that including patient perspectives and values in an EHR could save physicians time when deliberating treatments.
“We are finding there are very few things where one size fits all in medicine,” Dr. Mafi said.
Alice Borrelli, director of Global Health and Workforce Policy, observed in a later panel discussion that a lack of adaptation and willingness to work with vendors undermines the benefits of the HITECH Act, which gives patients access to their own health information.
Making electronic health records more accessible to low-income patients
Ivor Horn, MD, medical director of the Center of Diversity and Health Equity at Seattle Children’s Hospital, pointed out several concerns as health records become more accessible to patients. For example, most health records are written in English, which will be difficult for families with limited English proficiency or limited health literacy to understand.
For low-income patients, who often do not speak English proficiently or have limited access to computers, the sharing of electronic medical records may be less available. Dr. Horn called for innovation to make EHRs accessible to patients of all income levels and language proficiencies.
EHR data is often out of context
Dr. Horn also raised the issue of analyzing healthcare out of context and the potential use of other data analytics methods to compensate for not knowing the conditions of a patient’s life outside the clinic.
For example, when a child is overweight on his or her medical record, physicians have no way of knowing what kind of food is available in schools or what exercise is regular during the recess hours, Dr. Horn said. A better collaboration of systems could provide a more holistic view of health.
Trouble with data interpretation
Annie Fine, MD, the medical director of data analysis and reportable disease at the New York City Department of Health and Mental Hygiene, said many EHR systems are able to store data, but the inability to exchage information detracts from providing the best care possible. She suggested pulling critical points out of a patient’s health record and linking them together on a population database to track population health.
Aneesh Chopra, the former U.S. Chief Technology Officer, observed in another panel that Americans expect interoperability between other electronic systems but EHRs have lagged behind. He said it was not entirely up to the vendors to innovate — much of it falls on the physicians and developers to teach themselves and tweak things in the system as needed.
Using mobile data and social media to track population health
Dr. Fine, in answering a question, discussed the ethics of sharing patient information to track a potential outbreak. For instance, if a city health department identified a patient zero, would the rest of the population be able to use their cell phone’s geolocation to detect if they had been near enough to the patient to contract the illness?
She said that while ultimately the information would be useful, she might try other methods first, such as announcing it through the city office before allowing patients to track the data themselves.
