Articles

The healthcare industry in the United States is fighting a battle that’s been going on for decades. I’m not talking about the battle against cancer, the Zika virus or even ebola. I’m talking about the battle over electronic health records management (EHR). Despite amazing progress in these other areas of disease, the reality of the top hospitals, medical practices and healthcare networks in the U.S. is that keeping patient records safe, secure, up-to-date and easy to share has not been solved.
Most patients entering a hospital or ER in the U.S. still expect to fill out paper forms on a clipboard before any other healthcare concern is addressed. Healthcare records share an ironic fate of often being unavailable when needed by a patient and doctor but available for hacking when an EHR data breech occurs. The leading EHR companies are silos, disconnected from other providers and holding the healthcare industry back from real integration across the healthcare ecosystem. The key concern now is interoperability and new digital health startups are beginning to challenge these older established EHR providers. We may finally be leaving the back office paper medical records paradigm behind, but it’s been a long and painful process.

Different terms, one reality

Even the many terms for managing patient data demonstrate the evolution in how the industry views the business of collecting and sharing healthcare records.  ERM (Electronic Medical Records) was the earlier term used and now usually means digital records kept at one location, mostly not shared with the patient nor with the whole healthcare system. EHR (Electronic Health Records) is the current acronym and used to describe healthcare data that can be “created, managed, consulted by authorized clinicians and staff across more than one healthcare organization” according to The National Alliance for Health Information Technology. EHR records should also be shared with the patient creating new challenges in terms of transparency.

Other important acronyms in this area include CMS (The Centers for Medicare & Medicaid Services) previously known as the Health Care Financing Administration (HCFA). This is the federal agency within the United States Department of Health and Human Services (DHHS) that administers Medicare and works with the state governments on a range of healthcare standards and has responsibilities for administrative simplification standards from the Health Insurance Portability and Accountability Act of (HIPAA).

Then there is The American Recovery and Reinvestment Act (ARRA), which authorizes CMS to provide reimbursement incentives for doctors and hospitals who have qualified as “Meaningful Users” of the EHR system. These incentive payments started in 2011 and as of 2015, those using EHR had to be in compliance with the government’s “Meaningful Use” definition or could be subject to financial penalties under Medicare.

Lack of interoperabilty

For many years, the leading EMR provider has been a Wisconsin-based company called “Epic” and has been under fire lately for being unwilling to put interoperability ahead of competition with others in the EHR landscape. A recent story in liberal magazine Mother Jones by Patrick Caldwell tells the story in one headline, “We’ve Spent Billions to Fix Our Medical Records, and They’re Still a Mess. Here’s Why.” He discusses how most of the healthcare companies in the U.S. have fought to compete against one another and now are being asked to cooperate by the government to promote new solutions. Lack of interoperability is not an easy malady to cure, but is essential if EHR will reach the level it must for the future of digital healthcare integration in the U.S.  

Some startups are moving the lines

There is light at the end of the tunnel as new startups like Redox are beginning to change the game.  Redox is made up of former Epic employees who left to found their company in July 2014. They have created API integrating software with EHRs. Redox took part in the demo day at DreamIT Health Accelerator in Baltimore. They got $3.53M in funding by October 2015.

Other digital health startups working in the EHR area are also looking at an API integration model like Health Catalyst and Mulesoft.  Practice Fusion is a free, cloud-based solution, which relies on advertising and partnerships. Practice Fusion has gotten a lot of funding (US$155.02M) and a lot of press as it is backed by Peter Thiel, the early PayPal co-founder.