So I was out walking in the cold early this morning in my never-ending Battle of the Bulge, when an idea occurred to me. Amongst all the heated debate on healthcare reform over the past few years, one thing I have consistently heard from multiple sources is a call for greater implementation of electronic health records.
As a physician, I have heard many folks not involved in providing healthcare decry physicians for not embracing this great panacea, as though a profession which typically dwells on the cutting edge of technological achievement when it comes to diagnostic and therapeutic modalities is for some mysterious reason determined to remain total luddites when it comes to maintaining records of their patients.
Well, the simple fact of the matter is that physicians are not opposed to embracing information technology. However, unlike the academics, politicians, journalists, etc. who all condescendingly criticize the medical profession for it’s lack of alacrity in implementing electronic health records, practicing physicians do have to make their living in the actual environment of medical practice. In a nutshell, if a new technology enhances their ability help patients and/or makes them more efficient, they are pretty quick to embrace it. If, on the other hand, a new technology simply adds financial burdens without any clear benefits, or worse yet creates barriers to effective and efficient medical practice, they are understandably going to be hesitant to embrace it. The later is the current situation with most iterations of electronic health records.
As a practicing physician, I am very much in favor of using the latest technology to store and retrieve data on my patients. I have spent countless hours exploring various software packages and systems in the hope of finding a good system that can be implemented into my own practice to enhance patient safety, improve my efficiency, and ultimately lead to better and more effective patient care. Unfortunately, like most physicians, my search has been largely in vain. The overwhelming majority of systems I have encountered have either been prohibitively expensive, poorly executed or both. Most of the systems I have reviewed actually have the effect of making me slower and less effective in my practice. The most recent one I tried actually took over an hour for me to finish the documentation of a single patient encounter and the resultant document was a disjointed mishmash of little clinical value. Using a pen and paper, I can still produce a superior document in a few minutes.
So, why is it that other industries are able to integrate computers so well into their systems, but the healthcare system has so much trouble?
It has to do with the overwhelmingly disjointed and confusing documentation and billing requirements dictated to us by the bureaucrats at the Centers for Medicare and Medicaid Services (CMS).
Integrating their bizarro-world requirements with the various bits of information associated with each individual patient is difficult to say the least. Unlike other industries where they are simply inputting and storing demographic data, medical records include all the demographics plus information from multiple sources such as reports from specialists, lists of medications and dosages, allergies, medical and surgical histories, family medical history, values from hundreds of laboratory tests, etc., etc. All of these various other sources present their information in a variety of formats ranging from handwritten notes, to electronic documents, to hard-copy x-ray films, and more.
On top of all of that, the physician must be constantly vigilant to document his or her records with the assumption that they will potentially be read to a jury by some ambulance chaser some day.
Software companies that attempt to create an effective system soon find themselves in a situation not unlike trying to “herd cats.” While not impossible, it certainly isn’t easy. As alluded to earlier, the overwhelming majority of systems I have toyed around with fall woefully short. The relatively few systems I have encountered which do a passable job have been ridiculously expensive, typically requiring a tremendous investment not only in equipment and in time implementing the system, but also in continued product support to keep the “cat herd” moving.
So, what was this idea that occurred to me as I was out walking this morning?
Well, of all the electronic health record systems I have used and explored, there was one system that I actually grew to like. After using it for about a month or so, I actually found that it started improving my efficiency and speed. Further this system seemed able to satisfy the draconian documentation requirements put forth by CMS and was able to translate patient information into billing information pretty reliably. Finally, this system was designed to beautifully integrate the health record across various practice settings automatically. In other words, if a primary care physician saw the patient, he could easily pull up records from the various specialists, x-ray reports, laboratory reports, prescription history, etc.
To be sure, this system is not perfect. It does require an investment in equipment as well as product support, etc. and does have somewhat of a learning curve, but overall, it’s the best system I’ve fooled around with.
Where did I encounter this system?
I encountered it while working in a U.S. Army clinic in Germany. The system was knows as CHCS II, which stands for Composite Health Care System II.
Basically, this is the electronic health record being integrated into the military healthcare system. Since my time in Germany, it is my understanding that it has been renamed AHLTA, which stands for Armed Forces Health Longitudinal Technology Application.
Man, the military sure does love its acronyms!
Anyway, here’s my brilliant idea that occurred to me this morning.
The U.S. government should make this system available for free to the civilian world.
There are many good reasons for our good ole Uncle Sam (not to be confused with our good ole DrSam) to do this.
1. CMS has a long stated goal of forcing electronic health records on the U.S. healthcare system. This would go a long way toward achieving this goal.
2. There are currently about 10 million U.S. citizens (military personal and their dependents, etc) who already have their personal health records contained within this system. When they leave the military or otherwise have to interact with the civilian healthcare system, their information would already be available.
3. As future people enlist into the military, their civilian health records could seamlessly follow them, enhancing the military healthcare providers ability to deliver good care.
4. Most folks working within the military healthcare system, eventually leave the military and go to work in the civilian sector. They would already be familiar with and well versed in this system making this transition much easier for them.
5. Finally, and perhaps most importantly from a strategic standpoint, the military would benefit from the inverse of number 3 above. For the most part, folks working within the military healthcare system do all or most of their training in the civilian world. By having the same electronic health records system in place in both the civilian and military healthcare environments, folks entering the military would already be familiar with the system, allowing them to quickly integrate into the military system and get busy with caring for patients. Strategically, in the worst case scenario where the U.S. finds itself involved in a large war requiring conscription of large numbers of medical personal, the value of having those folks able to get to work efficiently and quickly cannot be overstated.
CMS has been increasingly demanding use of electronic health records. Until now, this has been essentially a monumental, unfunded mandate.
The idea I present above, gives our dear Uncle Sam the rare opportunity to actually put out a funded mandate. Our Uncle has already spent several billion dollars of OUR money developing this electronic health records system. Similar to the Interstate Highway System and the Internet, which were also originally implemented for military purposes, but soon proved highly beneficial to our society as a whole, I think making AHLTA, (or whatever acronym the guys in uniform decide to call it next month) available for free download is a win-win for almost everyone.
I say “almost” because I am sure that an army of lobbyist for the companies currently marketing various electronic health record systems to the civilian healthcare marketplace would do everything in their power to prevent my proposal from ever happening.
To me, this would be similar to companies operating bumpy, pot-hole filled, two-lane toll roads attempting to block civilian access to the Interstate Highways.
So, how about it folks? What do you think of my idea?