By Elizabeth A. Regan
If you got the COVID-19 shot, you likely received a little paper card that shows you’ve been vaccinated. Make sure you keep that card in a safe place. There is no coordinated way to share information about who has been vaccinated and who has not.
That is just one of the glaring flaws that COVID-19 has revealed about the U.S. health care system: It doesn’t share health information well. Coordination between public health agencies and medical providers is lacking . Technical and regulatory restrictions impede use of digital technologies. To put it bluntly, our health care delivery system is failing patients. Prolonged disputes about the Affordable Care Act and rising health care costs have done little to help; the problems go beyond insurance and access.
I have spent most of my career within the domain of information technology and IT-based innovation and systems engineering. As a professor of health informatics , I have focused on health care transformation. For two years, I served on the Health Innovation Committee at HIMSS , the pre-eminent global health information and technology organization. In short, I have studied these problems for decades, and I can tell you that most of them aren’t about medicine or technology. Rather, they are about the inability of our delivery system to meet the evolving needs of patients.
We need a high-performance system
In reality, the U.S. health-care sector is not a system at all. Instead, it is an underperforming conglomerate of independent entities : hospitals, clinics, community-health and urgent-care centers, individual practitioners, small group practices, pharmacy and retail outlets, and more, most of which compete for profits and in some cases pay sky-high salaries to executives.
These entities often function in silos. Errors, gaps, duplication of services and poor patient outcomes are often the result .
Here’s an example: A heart-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 her doctor nor the facility knows the patient was even hospitalized, nor do they have access to her records or medication list.
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Shopping for doctors
For patients, this might mean a disjointed set of services that don’t offer a coordinated plan of care or even a timely or comprehensive diagnosis of their health problems. Patients with chronic conditions often see more than 10 different doctors during dozens of office visits a year .
The specialist may not even be aware when the patient doesn’t return. Patient information is seldom shared; specialists are often associated with different medical systems that don’t share records. And even when they try, accurately matching 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 health-care delivery system. Bringing systems engineering and information technologies to medical practice can help make that happen, but doing that requires a holistic approach.
Let’s start with electronic health records. More than 20 years ago, the Institute of Medicine called for the transition from paper to digital health records. This would allow patients to easily share lab, imaging and other test results with different providers. Nearly a decade went by before action occurred on the recommendation. In 2009, the HITECH Act was passed, which provided $30 billion of incentives for the transition.
Yet now, 12 years down the road, we’re still a long way from a patient’s electronic health records becoming universally available at the point of care. Connectivity across systems and networks remains fragmented, and a lack of trust between organizations, along with anticompetitive behavior, results in an unwillingness to share patient information.