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The disconnect between EHRs and health information exchange


You've spent a lot of time and money trying to attain meaningful use with your electronic health record system, but you still have to phone or fax over records. Find out the reason why.

Key Points

Electronic health record (EHR) systems, e-prescribing, computerized physician order entry (CPOE), and health information exchanges (HIEs) are generally recognized as the core set of any large-scale health information technology (HIT) initiative. Industry spokespersons specifically indicate that these technologies, and more, are critical to the future of the country's healthcare industry. EHRs, however, along with functioning HIEs, are the two most crucial components. Without them, the other technologies have no method of communicating and exchanging patient data.

So, how is the development and implementation of these two critical technologies coming along, and how do they affect primary care?

True HIE means that primary care physicians (PCPs) and medical specialists can share a common set of patient records that are constantly updated and available to each of them instantly. In theory, this capability is the way EHRs have improved healthcare. In reality, however, fax machines still handle the bulk of external and internal communications between PCPs, specialist, and hospitals. And according to Laine, healthcare stakeholders show little interest in accomplishing a viable standard for true health data exchange.

Laine practices at one healthcare institution in Philadelphia, Pennsylvania. Frequently, however, she sees patients who have been treated previously by emergency departments, specialists, and physicians at other hospitals. She says that when she needs the data from a patient's previous encounters, her staff members must fax the patient's signed consent form over to the hospital or specialist. They then must wait for the patient's data to arrive, sometimes for extended periods of time. "It's unusual to get the information that day, while the patient is here," she says.

The lack of immediate access to her patients' records from other healthcare entities, Laine says, interferes with her ability to provide the level of care that would be possible if her patients could simply pre-emptively grant her total access to their encounter records with the other physicians. "To be able to get that information about those visits that are occurring in other settings would be really valuable," she says.

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Jennifer N. Lee, MD, FAAFP
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© National Institute for Occupational Safety and Health
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