FINAL REPORT: Electronic Medical Records

According to the Centers for Disease Control and Prevention (CDC), during an average year, Americans make over 1.2 billion visits to either physician offices or hospital outpatient and emergency departments. That number translates to an average of more than four visits per year by each man, woman, and child residing in the United States. More than 15,000 ambulance services across the country annually transport more than 16 million patients to emergency departments, almost 44,000 every day, while thousands of other patients are transported to other healthcare facilities. The patients transported in those ambulances, their destinations, their current locations, their diagnoses, and their treatments en route are all data that can be tracked electronically.

As electronic data, patient information can be managed and shared, in real time, across the healthcare spectrum in order to optimize care and help save lives. This is true for routine daily transports, but is even more critical during a disaster response when emergency managers struggle to efficiently process large numbers of patients at multiple healthcare facilities. Managers try to ensure that each patient is transported to the facility best-suited for each patient’s needs, but efforts during disaster scenarios too often result in separated families struggling to find each other. Ironically, tracking systems used by shipping agencies such as FedEx often make it easier toentify the sender, contents, and even current location of a package shipped across the country (or around the world) than toentify and locate a patient being transported across a city.

The American healthcare system generates millions of medical records every day; each ambulance transport generates a Patient Care Report, each hospital visit generates a medical record, and each follow-up visit to a physician generates another medical record. Far more than a billion new medical records are created in the United States each year. Many but not all of these records – each a vital piece of data that is needed by all members of the healthcare community to ensure patients receive proper care – are already being stored electronically.

Unfortunately, the current electronic records are often stored in multiple databases that do not “speak” with one another. In an era of reduced resources, some healthcare experts make a compelling argument by projecting that a nationwide electronic medical records (EMR) system could have significant cost benefits. For example, Greenway Medical Technologies claims that “widespread implementation of interoperable and integrated [EMR] solutions can save the American healthcare system upwards of $200-$300 billion per year through increased efficiencies, increased care quality, reduction of superfluous procedures, and enhanced antifraud safeguards.” Other estimates suggest that the use of EMRs could also save many lives, by eliminating medical care errors. On 30 May 2008, U.S. Rep. Adam Smith (WA-09) stated that “health IT [Information Technology] could save thousands of lives each year by directly improving the quality of our nation’s health care delivery system.”

Significant investments are being made to modernize health IT systems. In 2005, the American National Standards Institute created the Healthcare Information Technology Standards Panel. More recently, funding has stemmed from the 2009 American Recovery and Reinvestment Act – including significant funds for enacting the Health Information Technology for Economic and Clinical Health (HITECH). The U.S. Department of Health & Human Services has been working on the Nationwide Health Information Network (NwHIN) – “an infrastructure that will connect providers, consumers, and others involved in supporting health and healthcare.” Also underway are initiatives for healthcare entities to directly send health data point-to-point using a secure email backbone.

The current health IT system is highly dependent on local health systems and local and state public health officials. In addition to the challenges of implementing vast new technology systems and networks that are capable of guaranteeing the privacy and security of each and every record, local officials are struggling toentify funding sources, while simultaneously trying to convince the public that these systems will improve their healthcare experience.

New and emerging technologies in health IT include standardized medical record formatting that enables interfaces across healthcare systems, health information exchanges (HIEs) that facilitate the electronic transfer of those records, and global information system (GIS) technologies that locate and facilitate the management of patient transport.

Key Findings

• Roughly three-fourths of both sets of respondents believe that the use of tracking technologies during any significant event would well serve their communities.
• Less than one third of respondents reported that their communities have deployed electronic systems for sharing health records – and, of those, half are sharing that information only within their individual agency, hospital, or healthcare system.
• Only one third of respondents believe there is proper security in place to protect the privacy and information of individuals included in a universal HIE.
• On average, more than 80% of respondents believe there is either “some value” or “a lot of value” in the use of these technologies in each surveyed use case, including routine use: (a) by Emergency Medical Services (EMS) in their electronic patient care reports (ePCRs) and hospitals in their EMRs; (b) by government agencies to improve community preparedness planning; and (c) by the nation’s overall healthcare and response communities during disasters.