When Electronic Health Records Tell Only Part of the Story

“It Should Be in My Records”

Doctor talks on phone while checking his notes
Reza Estakhrian/Stone/Getty

As more hospitals and medical offices transition from paper to electronic health records (EHRs), clinicians are enjoying the ability to access critical health information generated by previous health care encounters within their own organization. Instead of hunting down and flipping through a thick paper chart, a physician can use the EHR to view a patient’s test results, vital signs, and progress notes from previous visits in the same clinic or previous encounters in the same hospital system.

However, many patients receive health care from multiple organizations. For example, a patient may see a primary care physician in one system and a gynecologist in another system. Before EHRs, these organizations would maintain their own paper records, each one telling a chapter of the patient’s health history, but not the whole story. Just as health care is fragmented, so was health data.

Unfortunately, little has changed with EHRs. Just because organizations now store health information electronically, it does not guarantee that they share data with each other. EHRs alone do not solve one of the major challenges facing the medical field today -- that is, the need for rapid and seamless exchange of health information among disparate health care organizations to support patient care.

Example of fragmented health information

Consider the following scenario. A patient, Mr Smith, was recently hospitalized for pneumonia and is now seeing his primary care physician, Dr Lopez, in the office for a follow-up visit.

Mr Smith mentions that an ultrasound during his hospitalization found a large cyst on one of his kidneys. Naturally, Dr Lopez wants to view this information to determine if further testing or treatment is necessary.

“It should be in my records,” says Mr Smith. A reasonable assumption.

Yes, the information resides in the hospital’s EHR, but it isn’t present in the EHR used by Dr Lopez’s office.

How can Dr Lopez access the critical information from Mr Smith’s hospital stay? There are two main options, and neither are ideal:

1. If Dr Lopez has privileges at the hospital, she can log on to the hospital EHR, view Mr Smith’s data, and print it out.

2. If Dr Lopez cannot access the hospital EHR, then Mr Smith would need to given written authorization for the hospital to release the information to Dr Lopez. The hospital would then fax or mail the information to Dr Lopez. This process could take days or weeks.

In either case, the information is in paper format and would have to be scanned into Dr Lopez’s EHR. This is a cumbersome practice that is not much different than the old days.

When separate EHRs do not communicate with each other, then the information simply isn’t “in my records,” from the patient’s viewpoint. Despite the many benefits of EHRs, they do not grant seamless access to health information from multiple health care organizations.

What happens when EHRs don’t share information?

When health care providers are unable to view information from another facility in a timely manner, they lack the data needed to make good decisions about the next steps in a patient’s care. This may lead to a delay in diagnosis or treatment. Duplicate testing occurs when health care providers can’t view prior tests results (blood work, ultrasounds, CT scans, etc) and subsequently order the identical tests again. This is a waste of time and money, and may also expose the patient to unnecessary risk associated with the test itself.

Read here about the solution: Health Information Exchange.

Sources:

Stewart BA et al. A preliminary look at duplicate testing associated with lack of electronic health record interoperability for transferred patients. J Am Med Inform Assoc 2010;17(3):341-4. Accessed on June 5, 2014.

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