Dr. Alan Kumar was on duty when a man in his 60s entered the emergency room at Community Hospital in Northwest Indiana.
Kumar said the man was so uncomfortable, Community was the third hospital he’d visited that day.
“He felt he wasn’t getting answers and presented here as a last hope,” recalled Kumar.
Kumar said the whole family knew “something was wrong and they don’t know what it was.”
Based on the symptoms, Kumar worried about a serious infection or cancer. “My initial plan was to do a full battery of lab tests, x-ray, CT scan,” he said. “That process would be four to six hours, and you are talking thousands of dollars.”
Instead, Kumar opened up the medical record, which included the other hospitals’ workups.
He was back with the patient in minutes.
Patient room at Community Hospital.
This is how patient data is supposed to move, effortlessly with competing hospitals sharing health records for the patients’ good.
When the government invested $30 billion dollars to get hospitals and docs these electronic health records this was the dream.
And now more than 96 percent of hospitals are digitized, nearly 80% of physician practices as well.
In short, the infrastructure to deliver on the promise of information sharing is there.
“Now the challenge is to move to connect and wire together all of the systems that have been adopted,” said Arien Malec, an executive with healthcare firm McKesson, which develops software. “That work is a little lumpy.”
One reason work is "lumpy" is that you’ve got hundreds of vendors with systems that often don’t talk to each other, as if an iPhone couldn’t call an Android.
So vendors have banded together to find the solution.
“Technology is the easy part,” said former health IT official Jodi Daniel, now an attorney at Crowell and Moring.
“The really challenging part is the business issues the operational issues and the trust issues with exchanging information,” she said.
That’s never easy when you’ve got natural competitors trying to collaborate.
One significant problem: vendors charging hospitals and docs to share patient data.
“We are struggling and struggling and beating our heads against the wall every day,” said Farzad Mostashari, the former Health IT czar at HHS.
Now, Mostashari heads up Aledade, a firm that help primary care physicians better coordinate care.
Mostashari points to a New York doctor who wanted to link his electronic health records to another system.
“And the vendor is saying, ‘Oh, OK that will cost you $50,000.’ Now, does it cost the vendor $50,000 to build a standard interface? No it doesn’t cost them $50,000,” said Mostashari. “It’s their opportunity to make a buck.”
Sharing patient data, as Dr. Kumar was able to do in Indiana, can improve care and lowers costs.
But that runs counter to the financial incentives for the software vendors.
Mostashari says it’s time for a national conversation. “The question is in healthcare are we OK with people saying there is some lifesaving information. but if you don’t pay, you don’t get it?” he said.
Washington, D.C. is paying attention.
Federal health officials have pushed Congress for more oversight to ensure health records are built to share information out of the box.
Dr. Karen DeSalvo, the National Coordinator for Health Information Technology, has urged vendors to be up front with their physician and hospital clients about how much it will cost to exchange data.
DeSalvo said steps like this help the young industry grow up.
“You are seeing a lot of activity on the Hill, and certainly from us requesting additional authorities to make sure the systems are working and the marketplace is working for others,” she said.
As the nation pushes closer to real-time information sharing, it forces health leaders and politicians to grapple with the reality that there’s a fortune to be made from this data, and whether anyone should profit from it.