| | July 20159While the challenges of `unified' electronic health records are huge, the benefits of interoperability seem to outweigh the challenges, assuming that with enough effort the challenges can be overcome"HTRobert Sawickihave been exposed to his illness, which might have been contagious (think of how this could have played out if this were something like SARS). Sure, much of this was communication breakdown, but the underlying root cause was the lack of records interface. Oddly enough, a few months later, Cindy developed a torn meniscus in her knee. Her orthopedic surgeon usu-ally worked at a surgi-center of which he was part owner, but Cindy's insur-ance did not have a contract with that center. Surgery was scheduled at the surgi-center that was also in the main hospital building (though in the outpa-tient wing, distinct from the inpatient operating rooms). Since surgery was at a different location than usual, staff had to call for OR time, as opposed to the usual location where they could see the schedule and enter in to it from the office. Then there were issues around get-ting pre-op tests scheduled. These were finally done on a Thursday. The hospital-based surgi-center was closed on Fri-days, and surgery was scheduled for 8 AM Monday. On arrival, anesthesia finds that the EKG was abnormal. No old tracings were found, so the proce-dure was cancelled, and a cardiology consult ordered. This required schedul-ing through Cindy's primary care office, which again took several days. Steve (a physician, remember) had taken time off to be with Cindy Monday, and then again to see the cardiologist, and ultimately a third time for the surgery when it did happen. The cardiology office, which is in the same building as the surgi-center, directly upstairs, made Cindy fill out a six page medical history, even though they were part of the multi-specialty group that also employed Cindy's primary care physi-cian. They must not share records, even though they use the same platform. A cursory review of the EKG revealed it to be a normal variant; Cindy had no real risk factors, and was cleared for sur-gery. Why no one thought to simply call the cardiologist from the surgi-center is not clear, though ultimately, I wonder if he would not have required a visit any-way, for liability protection. Either way, the time spent felt like a huge waste to Steve and Cindy. Not to mention the disruption, and certainly, there was no good reason an abnormality found Thursday was not seen by someone before Monday, in which case resched-uling could have happened sooner, re-ducing the inconvenience to them and to the orthopedist, among others.This is the story of what happened to a medically knowledgeable family. Imagine how much more difficult this would have been for someone with no knowledge of the "system". And while the issues here merely inconvenienced many people, there are plenty of other examples of similar issues that can lead to poor care, poor quality, and reduced satisfaction. While the challenges of "unified" electronic health records are huge, including issues around privacy, security, validity, etc., the benefits of interoperability seem to outweigh the challenges, assuming that with enough effort the challenges can be overcome. The way to do this is to look at technology from the perspective of the patient, not just the user. Functionality that can create efficiencies in one area, like billing, can create inefficiencies in another, like patient flow. Like Dr. Hawking, we should relentlessly pursue the goal, whether we can see the finish line or not. Like in physics, the things we learn along the way can be leveraged for the benefit of many. We can certainly improve on the stories above and others like them. Let's keep looking for that Theory of Everything.
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