If you got the COVID-19 vaccine, you probably received a small paper card that shows that you have been vaccinated. Make sure to keep the card in a safe place. There is no coordinated way to share information about who was vaccinated and who was not.
This is just one of the glaring flaws that COVID-19 has revealed about the health care system in the United States: it does not share health information well. There is a lack of coordination between public health agencies and medical service providers. Technical and regulatory restrictions prevent the use of digital technologies. To be honest, our health care delivery system is failing patients. Longstanding disputes over the Affordable Care Act and rising health care costs have helped little; the problems go beyond insurance and access.
I spent most of my career in the field of information technology and IT-based innovation and systems engineering. As a teacher of health informatics, I focused on health transformation. For two years, I served on the Health Innovation Committee at HIMSS, the most prominent global health technology and information organization. In short, I have studied these problems for decades and I can say that most of them are not about medicine or technology. Instead, they address the inability of our delivery system to meet the evolving needs of patients.
We need a high performance system
In reality, the healthcare industry in the United States is not a system. Instead, it is a conglomerate of underperforming independent entities: hospitals, clinics, community health and urgent care centers, individual doctors, small group practices, pharmacies and retail stores and more, most of which compete for profits and, in some cases, pay much more. high salaries for executives.
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These entities generally operate in silos. Errors, gaps, duplication of services and poor patient outcomes are often the result.
Here is an example: a cardiac surgery patient, still on oxygen and in intensive care just two days earlier, is referred to her primary care physician for follow-up and to a rehabilitation center for therapy. Neither your doctor nor the institution knows that the patient has been hospitalized, nor do they have access to your records or medication list.
Buying for doctors
For patients, this can mean a disjointed set of services that do not offer a coordinated care plan or even a timely or comprehensive diagnosis of their health problems. Chronic disease patients often see more than 10 different doctors during dozens of consultations a year.
The specialist may not even notice when the patient does not return. Patient information is rarely shared; specialists are often associated with different medical systems that do not share records. And even when they try, the accurate matching of patient IDs in different systems can be problematic.
The challenge now is to transform the status quo into a high-performance system, a true 21st century healthcare delivery system. Bringing systems engineering and information technology into medical practice can help make that happen, but doing this requires a holistic approach.
Let’s start with electronic health records. More than 20 years ago, the Institute of Medicine requested the transition from paper-based to digital health records. This would allow patients to easily share laboratory, imaging and other test results with different providers. Almost a decade passed before the action took place on the recommendation. In 2009, the HITECH Act was passed, which provided $ 30 billion in incentives for the transition.
However, now, 12 years later, we are still a long way from a patient’s electronic health records becoming universally available at the point of care. Connectivity between systems and networks remains fragmented and the lack of trust between organizations, along with anti-competitive behavior, results in a reluctance to share patient information.
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Unsafe medical treatment
A system failure is the inability to accurately identify and compare patient records. There are few standards for collecting patient information. With hundreds of suppliers and thousands of hospitals, doctors’ offices, pharmacies and other facilities participating in the process, the variation is enormous. Is John Doe at 250 Park Ridge Drive the same as John E. Doe at 250 Parkridge?
In 2017, the American Hospital Association estimated that 45% of major hospitals reported difficulties in correctly identifying patients in information technology systems. This means that, at least sometimes, doctors are making decisions that increase the chances of misdiagnosis, unsafe medical treatment and duplicate tests.
During a public health emergency like COVID-19, accurate patient identification is one of the most difficult operational problems a hospital faces. The exact results of the COVID-19 test are made difficult when samples, sent to public health laboratories, are accompanied by patient identification errors and inadequate demographic data. Results can be sent to the wrong patient or, at best, can be accumulated.
These mistakes are also costly. More than a third of all denied claims result directly from incorrect patient identification or incorrect or incomplete information. This costs the United States health care facility an average of $ 1.2 million a year.
Congress needs to act
For nearly two decades, the Department of Health and Human Services has been prevented from spending federal dollars to adopt a unique health identifier for patients. To remedy the problem, the United States House of Representatives in July 2020 unanimously approved an amendment allowing HHS to evaluate patient identification solutions that still protect patient privacy. But the Senate chose not to address the issue. Still, many health leaders are defending the action of the new Congress. Health advocates are hopeful that the new Senate majority leader will be more receptive to addressing the issue.
One positive point in all of this is that many health systems saw the benefits of telemedicine during the pandemic. It is convenient for patients, saves money and meets the needs of patients with limited mobility. Telemedicine may be just the beginning; with an increasing variety of mobile health devices, doctors can monitor a patient at home, rather than in an institution. More must be done, however. During the pandemic, some patients, with a lack of access to broadband or poor Wi-Fi, had something less than a rich and uninterrupted visit.
IT health advocates have long envisioned a healthcare system that seamlessly uses connected care to improve patient outcomes and cost less. When the pandemic subsides, the exemptions and policies temporarily adopted will require not a sudden termination, but a transition to such a system.
Last year, doctors, nurses and healthcare systems learned lessons out of necessity. Instead of abandoning our new knowledge, I believe that we need to double towards a modern, stable and values-based health care system with equality for all. And at its heart there must be a certainty: that accurate and comprehensive patient records are always available at the place of care.
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