When visiting a doctor, the average patient’s experience is recorded within at least 3 different information systems of record. That same patient also sees 18.7 different doctors in his or her lifetime. For patients over 65 years of age, the average increases to 28.4 individual doctors, including primary care, specialists, hospital and urgent care providers. Between all of these doctors and all of these systems, there is little-to-no communication. This leaves a patient’s medical record scattered across many different types of systems controlled by many different IT departments and behind many different firewalls. This renders the patient, and their respective providers, lacking a holistic view of the patient’s health.
· The average patient visit generates 13 pieces of paper and the average paper medical chart weighs 1.5 lbs according to the Institute of Medicine.
· 195,000 deaths a year are attributed to preventable hospital medical errors according to HealthGrades.
· At least 1.5 million Americans are sickened, injured or killed each year by errors in prescribing, dispensing and taking medications according to the Institute of Medicine.
In addition to information reported by care providers, patients themselves have become a large source of data related to their everyday behaviors. This data is collected and reported via common wearable devices, such as Fitbit or Apple Watch. The combination of this patient-reported and physician-reported data has the potential to revolutionize individualized patient care by looking for common patterns in behavior that can predict the occurrence of negative health conditions.
We cannot have an individual’s health information scattered everywhere and have some information held only by the healthcare system and some by the individual. There must be a way to facilitate a deeper, richer dialogue within the context of existing doctor-patient relationships. To achieve this more coherent and comprehensive healthcare, we need to bring together the patient, her digital health information from new sources (i.e. data collected by mobile apps, sensors, and other tools), the doctor, and the EHR.
Then, we need to make it easy for physicians to access new sources of patient generated data, and data from other EHR systems within the context of their daily work within their own EHR systems. Physicians are not going to launch and log-on to their EHR and three different applications to compare data or to view disease-specific data visualizations, no matter how cool the new app may be. Moreover, physicians should be able to do clinical documentation, make a therapy change, or order further diagnostic testing from within the confines of their existing EHR system.
Clinicians will only use new information sources when they are helpful and add value by weaving together a comprehensive view of a patient’s health information that facilitates better conversations between individuals and their doctors, and thus better care. This means that patient generated data cannot be siloed off from the EHR. Instead, it must be incorporated into clinical workflows as part of the physician’s or Hospital’s EHR system.
With all of this information passing back and forth, the system needs to be capable of sending and receiving messages between the doctor, patient, family members, and other care team members. Nobody will want to log-on to every individual system and account to look for information or check messages.
We need interoperability solutions that can connect to EHR systems anywhere. The mobile app on the patient’s phone needs to become the ‘hub’ EHR system from which the user sends and receives medical records to and from whoever they choose and authorize. In essence, the ‘hub’ EHR system running on the patient’s mobile phone becomes a HIE of 1. The mobile app pulls the data out of various EHR systems using industry standards such as HL7 and FHIR and stores them in apps such as Apple HealthKit or Microsoft HealthVault for subsequent sharing, usage and analysis.